Laserfiche WebLink
477- PERMIT APPLICATION <br /> 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: QZ. 141^ epg'As PROPERTY TAX#: Z ,o SI 9,00 LD I2-OC. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: / /t.ell 4t 7(_ )Jf Yitti c=1 TENANT NAME(If Commerci I): <br /> OWNER MAILING ADDRESS: STREET ?710V &/(2...o4-I,c1)A-Y <br /> CITY t? STATE 4/4_ ZIP 9,8 e0 <br /> OWNER PHONE: (,Cf-) 5-- U,) '$ OWNER EMAIL: .J (-0(L►n1 . C ' n-.11 5Y7 , DYI-4-1 <br /> CONTRACTOR NAME: 'C F7, D !(i c-ti <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR OTHER(Please Specify) - Hit -J <br /> CONTACT NAME: CONTACT PHONE: 2_06 --4-71'7 <br /> Cj'��1/� / S I�171 0 �✓(�N�1 �71t1a,2? CONTACT EMAIL: '�� �'rl�ttl'1 c , <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: .(.. K��JY7s►rLT SC-NfUv I— Contract Price of Work: $ / <br /> try-t7 <br /> Proposed Use of Building: ..er-t l)-7,A1t2f ceji pc, -- Heat Source: ❑Gas f lectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: ,Commercial ❑Industrial <br /> Type of Project: , New ❑Addition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> t )?0&i U) ' z— �—`0.- 614 r-° 1,-)/ WAY.-fib R'►-A- S l,y►ILS <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 /> Chemical or Water 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 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 /> ..�_..._— "/ /6/)£� PERMIT# lq)(0 -47:7 <br /> Owner/Authorized Ag t Signature Date (Revised 9/23/201 ) 1 <br />