Laserfiche WebLink
PERMIT APPLICATIOI— <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4dg <br /> "IP4/Z//-':1 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: #2I t 144,-T.4 PROPERTY TAX#:07 -6. DOCee::1} <br /> LEGAL for new construction: Short Plat/subdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6-46 415 LAW-A 6 u �6 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (00040 r' -67Q t t 1.3 4,11F <br /> CITY 61161Sl STATE /44 - ZIP ei �///�� <br /> OWNER PHONE: 44-7.-&--- ;1/45---c,/ 2�Y OWNER EMAIL: <br /> CONTRACTOR NAME: 01rt K1e'Z <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 21 OTHER(Please Specify) A16QJ <br /> CONTACT NAME: IJ' 9 4.441:::F21) CONTACT PHONE: -4 V-6- '.7.-$G.--- .) <br /> CONTACT EMAIL: P4LA g Ai(,,,awn <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �j,F'Ia Contract Price of Work:$ ��43.42‘;'-- - ISie2 e j <br /> Proposed Use of Building: t12— Heat Source: ❑Gas VElectric ❑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: - �Y/ .-1-216_ r7�- d�L� App(r � - <br /> l� - J <br /> i' 'E ( e /WO P 1��.c4CF- /4-W G�CoJO Y' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): \, n b3- O3i <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New )( Addn Alteration Repair Type of Project: New ?c, Addn )Q 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 I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater ( Bathtub Urinal <br /> Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: f Clothes Washer Medical Gas <br /> l Range Hood Water Heater Other: <br /> v- Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> 220 t <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 Offici• .- .re being.ut'•rized 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 he State I ontra,ors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / II/ / PERMIT <br /> Own,r/•uthorized Agent Signat e / ate (Revised 9/23/2016) <br /> I <br />