Laserfiche WebLink
PERMIT APPLICATION■ <br /> /114f/—,fr:—A 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 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: b/S' 254 4f 6 6- -joEy (D PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot 11e. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -.3004“4,1,k,, L'a Kele H4,en,I TENANT NAME(If Commercial): -aOwak_ eath S <br /> OWNER MAILING ADDRESS: STREET (1( Cj .?$1k S# S C _ <br /> . - , CITY rfro /�:, STATE tel ZIP f O 2,0 '� <br /> OWNER PHONE: f-O(p• vr,1 2W OWNER EMAIL: Citt.,t iik,(j l41 c, ZD(v a ll siet i, e#444 <br /> CONTRACTOR NAME: (' -/ (014,4444ef to H✓ <br /> CONTRACTOR ADDRESS: STREET j // �� /CIL _c ;t?�J /� <br /> CITY red WA-I w �1.. e STATE (I., /f-- ZIP 7YOU <br /> CONTRACTOR PHONE: 7 l G , CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): G G p.., CoA,16 [�✓ti CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):04We�7 <br /> PRIMARY CONTACT: ,OWNER 0 CONT R/XCTOR 0< OTHER(Please Specify) r <br /> CONTACT NAME: CONTACT PHONE: C 4, 7S-,--C.7---Y1-7-2-4, <br /> yrnylif6.7 oh, CONTACT EMAIL: ydanq t%0 24 6 0 Y�AI 1'. 12-4)744, <br /> BUILDING PERMIT APPLICATION <br /> e1.- r .01-- <br /> (� <br /> Existing Use of Building: pIC A) Contract Price of Work:$ i % e At <br /> t ` 1. <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Oth r 1 <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family#of Units: ❑Commercial El Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel C Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �iG/0 QGP /Qo-9/orrt t-24.),...„,„,0 4, /�1 c�z i,�Z-�c�t: A e�i` •� ,t4„1 <br /> a.� <br /> b `uCcfCA .GlxS `J <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 #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 der 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 I comply with the State Contractors aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> I yoxv,„7 <br /> Owner/Authorized Agent S' nature Date (Revised 9/23/2016) <br />