Laserfiche WebLink
Oren. 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 1 FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /g/4;7/-01.21Z,cfY 9 # b/e-- "-ey.0.7490i,, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> dt, <br /> CONTACT INFORMATION <br /> OWNER NAME: �j�. `�c `!U! '/�?� — TENANT NAME(If Commercial): <br /> OWNER MAILING AD «DRESS: STREET /'v' 14r'y/. si r s� 4z-er <br /> CITY yid p-e• - j STATE / .4 ZIP7R,9 ( <br /> OWNER PHONE: e7/2_, 3 / ,ZT�e( OWNER EMAIL: <br /> CONTRACTOR NAME: • <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:,WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> • <br /> CONTACT NAME: CONTACT PHONE: 145- <br /> !.°5e <br /> 2-Uc'5e d4 d7 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION p <br /> Existing Use of Building: Contract Price of Work:$ OU . <br /> v� <br /> Proposed Use of Building: Heat Source: DGas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached DDuplex ❑Multi-Family#of Units: • DCommercial El Industrial <br /> • <br /> Type of Project: ❑New DAddition cRemodel DRepair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable):e t�4g, /(2,(24‘,"(� d'</j!� Yy •`%'�'�( <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration 1<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 t Ducting Dishwasher Roof Drains <br /> j Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> / _ Range Hood Water Heater Other: <br /> L SC 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 off Everett Official Use Only <br /> ,o, /g <br /> Owne orized Agent Signature Date (Revised 9/23/2016) <br />