Laserfiche WebLink
PERMIT APPLICATIOI II <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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 330 t-teaRkp f R.C,ctG( 1~k,etrel-(-tt7I(=tagsPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: se tav, or(-„in h L'P Q L i f,a k k TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET qao r"-zalicf / 0 <br /> CITY Fy. .v.- STATE u/ ZIP g,EQ0. <br /> OWNER PHONE:4..2 -c 29gO//(i OWNER EMAIL: ,4Cd` 0�y-14 At t-l4'[Sn ,cp14,,�, <br /> J <br /> CONTRACTOR NAME: Vf0 (;-ee... C-r/y), is r�►.(v TV- C J <br /> CONTRACTOR ADDRESS: STREET ,Z 2 Ig" �7(//,nOl Avi-A4 i."-e_ <br /> CITY 1 Lpe� / STATE wig ZIP 7j C.7( <br /> CONTRACTOR PHONE: 20(o G/7--6,2-2..g CONTRACTOR EMAIL: `� <br /> CONTRACTOR LICENSE#(REQUIRED): 'R0G.k G I O0Z FAQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �-ICIf (/ <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) dr__- amc <br /> CONTACT NAME: CONTACT PHONE: 2O Fj 617 622. 0 <br /> Ir 1 ,r <br /> deAf'--- <br /> .. <br /> �-e u . 4-8-k R f d� CONTACT EMAIL: ,$,-c, )tri S S 11,-e con. uc t-t voa@ iout 1.,coteN <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 4 -E Contract Price of Work:$ %'Ur/', , '/." 4'�`�ii• A,Z1000 <br /> Proposed Use of Building: wt E' • Heat Source: Xs ❑Electric ❑Other <br /> Building Type: . SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition -Xemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chang��eof Use <br /> (7 <br /> DESCRIPTION OF WORK: VAtJGAl Aeat V`aCr� ,to� IM, CVbt <br /> eSV4-eafrk4s. `Fro.v <br /> re v\A ode l <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 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 <br /> �Only <br /> , /l/L� I/ ///g/SY/ PERMITr r r — 611(5 <br /> � l <br /> Owner/Authorize Agent Signature e (Revised 9/23/2016) [ ( (J <br />