Laserfiche WebLink
M3 <br />PERMIT APPLICATIOM i, <br />BUILDA 1 MECHANICAL / PLUMBING / SIGN 14bRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ilj ,.O oO <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Z Ls7 ( ENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET s 44 A,1zf <br />CITY STATE kj ZIP 9g a <br />OWNER PHONE: 41o2!57- 92 6-' C? e3 <br />OWNER EMAIL: dIn <br />CONTRACTOR NAN, & <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(R QUIRED): <br />PRIMARY CONTACT; OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: OW N <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi -Family-# of Units: ❑Commercial ❑industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: A 60 Y F s Or- CofftX OUP&M <br />_ _ v 404 cap w pldsrle .004 '00"w OF'4;5� <br />CWAIGk MAD6`0; ,A� COAAaToR voilwo ros M s7low6f�• ,r- <br />.�—7'�dG1.l1D Y.4Lv6� PRFi'�ARdr1aN r4(,x,C� <br />3�ISv6,ATygV jd' 47B'77v4�' 0XA7sL'o Snips I <br />ASSOCIATED BUILDING PERMIT if a pllcaole).F6A PPAP40Oic SOAR ^r ah: # t <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: ,New _ Addn Alteration _,Repair <br />Type of Project: _,New _,-,Addn Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># Of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />l.1' <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />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. I am the owner, or l 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 T # r <br />g fl?avi�ad 9i�si�ntel <br />0 0 <br />a <br />