Laserfiche WebLink
4:77PERMIT APPLICATION <br /> BUILDIN 1ECHANICAL / PLUMBING / SIGN :: RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESSzi O n ,( _ to._T - PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> t.. ....,:: CONTACT INFORMATION <br /> OWNER NAME:Q TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET,?..014 Ptw lwks-i vc' q Q <br /> CI1Y i IKir STAT LP `\la01 <br /> OWNER PHONE: (Qp. - L OWNER EMAIL:iggp <br /> CONTRACTOR NAME:O 3L1• 1 Salmi <br /> CONTRACTOR ADDRESS: STREET4041 teot4_ 5f� <br /> CITY 7-g.11 STATE W A, zip gekaalp <br /> CONTRACTOR PHONE: -Von 1(4k-LA SQ CONTRACTOR EMAIL: tr...1fpe -(ty.,fgpL %NL.CO wk-. <br /> CONTRACTOR LICENSE#(REQUIRED): LV`/51 J FTJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):C (S-‘ " <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: "-Sko_-74.b - 0355 <br /> ACAo C& CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SF(_ Contract Price of Work:$ ),c1(k)c <br /> Proposed Use of Building: Heat Source: El Gas ❑Electric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New DAddition ❑Remodel ❑Repair DTA. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> -amu V-&c sow \J 5 A --- <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 Fixtures #of List of Fixtures #of 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 /> Number 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and l corn.i the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> dI City of Everett Official Use Only <br /> PERMIT# <br /> IS( I - 0Flo <br /> Owner/Authorized Agent Signature Date (Revised 10/122015) <br />