Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> �f 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 I www.everettwa.gov/permits <br /> tBIuu rBlack iInk.Only Please) ,g PROJECT SITE INFORMATION x 5 i t ' <br /> PROJECT SITE ADDRESS: 32-x- �'�1-?nwood /\&t, 0nif-kt-'6 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATIO <br /> OWNER NAME; P) t' CIYI-i-c.l c-c:-e\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 05p:3-- C i-en Wool hwe. Urn,A- A - B <br /> CITY EV�t-.e-F4- STATE LdA- ZIP q 8 V V 5 <br /> OWNER PHONE:01 ) 980•- JD)1�! OWNER EMAIL: 1 JA✓1. C41� C�i'rvlctn I.ow\ <br /> CONTRACTOR NAME: i'}flU 5 �''f t?i,`in" )'n C . �1 <br /> CONTRACTOR ADDRESS: STREET )SJ2?3 sy D/ 'Deb CITY .. - �IA f,OOy J STATE W� f _ zip (��`�CX <br /> CONTRACTOR PHONE:(-1 ) a- - 5 )c 3 Vl CONTRACTOR EMAIL: Co yd-a-4-6 ,eit d1, i G30\ <br /> CONTRACTOR LICENSE#(REQUIRED): le.... /.IC-�S ffl(i-t 3 A CITY OF EVERETT BUSINESS LICENSE#(REQUI D): 0419-co <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (a-O(2)--i-e,5 — '0 <br /> C h q(c 5 [-I n 1 CONTACT EMAIL: 1_yl/ <br /> 4'1 S V\C�'/� <br /> k-ii1ep� �e'�L .� ✓� <br /> r <br /> BUILDING'PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 3bC b <br /> Proposed Use of Building: Heat Source: CIGas Electric ❑Other <br /> Building Type: CISFR-Detached ❑SFR-Attached f$Duplex OMulti-Family-#of Units: ClCommercial Cllndustrial <br /> Type of Project: ❑New OAddition CDRemodel ❑Repair CIT.1. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i-e 0&tin \Do. -e,(-e-C r`L f\l/Y\Ct-te,3 i 1q WI i A-"-f- B. 2 i(C...e r 1111- -- <br /> e <br /> LI <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION ',:` ' '' PLUMBING"I`.PERiMiT APPLICATION <br /> Type of Project: New — Addn Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #of 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 /> d-, 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 /> `S RANKLE#./ PPRESSION"SYSTEM `' "` <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEOGEMENT.:I have reviewed this application and confirm the information contained herein is true and coned.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 befo ing au orized under an circumstance.l am the owner,ori am authorized by the owner of this property to perlonn the work for which application is made, <br /> an• comps with t tatei <br /> awl%/7 - W d 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PERMIT# � �... <br /> it 112-146 5, <br /> f Yl l�� b <br /> OwnerlAutho d Agent Date (Revised 9/23/2016) <br />