Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a 207 Ca/b' I/ / tQ � fh <br /> �ie�e7� �y f�ROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. J'(attach copy of long legal description) <br /> CONTACT.INFORMATION <br /> OWNER NAME TENANT BUSINESS NAME(Commercial): \an, <br /> 1,1'l I ( <br /> 1 <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: �r OWNER EMAIL: <br /> ( <br /> CONTRACTOR NAME: Ander Sell 0n s/Ca c-// ;/-7 <br /> CONTRACTOR ADDRESS: STREET 6 7/a? /I/. e i¢f e r e,,c/' <br /> cm, POO^t/4 h c STATE ae ZIP <br /> CONTRACTOR PHONE: 503 d 2.3 %3 9..3 CONTRACTOR EMAIL: c <br /> .....................) <br /> CONTRACTOR LICENSE#(REQUIRED):/9 N D E R C ?o7 D A/ CITY OF EVERETT BUSINESS LICENSE#(REQU ED):5:2Q(.9 <br /> PRIMARY CONTACT: 0 OWNER 2'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:1'Ank/t?Urr'i5 So3^.267-o3--?rCONTACTice:E,l6,2" 'Crn OCP;S �ahc7lerSen ConSf. Con; <br /> ban Fu s--3/Ler' ;2 s - us---3!30 CONTACT EMAIL: 0/1/t4/ler a.s/Sfi'Gcc/ t,tre S , c Olyr <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ 30, o a v <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ElChange of Use <br /> DESCRIPTION OF WORK: /, ,1-H s/a// A. Se c u.r,x• Door aZ .`rt S7‘a/7,a Gia SJ' ii/{moi d,4......, /4 /4,7ee d poor. <br /> 3. ,Tn s74// A Xece,o,L✓r0,si-/,�,'0 eac✓ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo _ <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-camp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/'SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federa,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Offi ial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l com y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> • City of Everett Official Use Only <br /> ....7::; )c--,'7.--7 G 7 PERM!�f �( _ 0(43 <br /> Owner/Authorized Agent SignatureY--) e Date (Revised 10/10/2018) S <br />