Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING /SI3200GN /SPRINKLER I DEMOLITION <br /> �i� CITY OF EVERETT PERMIT SERVICES <br /> CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Bkie or Black Ink Only Please) PROJECT SITE INFORMATION <br /> l(41 („044' r �.j <br /> PROJECT SITE ADDRESS: '� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SAn4. 5/11/41/U// TENANT NAME(If Commercial): Q✓//�- <br /> OWNER MAILING ADDRESS: STREET (//q c®yfrtn'_ef-(,)ca , v-en IAA ( / <br /> cm, 61) ' STATE LI ZIP 9V Z.63 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 41j )7L (-5, Ay-,./Ax/ ) , ( (J cf._C <br /> CONTRACTOR ADDRESS: STREET 2/61/0 660....._ C k 1i'zi•L. <br /> CITY /n o(4 4-/-(a Oce 1.eJ/ ,2i('G.(. STATE w4- ZIP 9c1.6 - <br /> CONTRACTOR PHONE: v25- --77(1-'7,Z,-2.77 CONTRACTOR EMAIL: a be_- [//(a q a 14,7 ,„1 () f" //,Gan.-1 <br /> CONTRACTOR LICENSE#(REQUIRED): r IfS of 2-I PP CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): �i <.6, <br /> PRIMARY CONTACT: 0 OWNER , CONTRACTOR 0 OTHER(Please Specify) ,, 0 <br /> CONTACTAME: CONTACT PHONE: 0D6._2,LtiO_66 c/5 '__ / A7 - 7 <br /> piii c�( M 1X501, CONTACT EMAIL: a ( j '/4G/vl , . (� ", O y,,tCt/ < , <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /-51Od <br /> Proposed Use of Building: Heat Source: ❑Gas L' lectric ther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑ mmercial ❑Industrial <br /> Type of Project: El New ❑Addition ERemodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler 0 emo(tion ❑Change of Use <br /> DESCRIPTION OF WORK: C014 V - - <br /> 6(0p / 4raNIA. 5'A/K.-- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair, Type of Project: New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of F' ures #of List of Fixtures #of 1st of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units He- 1 p Toilet B-lw Preventer(Inside Bldg) <br /> Forced Air Systems •nit -.:ter Bathtub ri <br /> Gas Piping Boiler Lavatory(Wash Basin) Drink] - ountain <br /> Water Heater R- '.-ration Shower Floo ain <br /> Gas Fireplace -•.,00d Stove Kitchen Sink&Disposal . --se Trap <br /> Gas Range \ Ducting Dishwasher 'oaf Drains <br /> Clothes Dryer Hoo..•s . Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater .— Other: <br /> Exhaust Fa . Sink(Se ' e/Bar/Mop Other: <br /> SPRIN LER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 federal,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 Official before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER frZt <br /> Owner/Authorized ,gent Signature Date (Revised 3/2016) ! <br /> / 1 <br />