Laserfiche WebLink
PERMIT APPLICATION 03 llIPP <br /> DULLDINECHANICAL/ PLUMBING/SIGN/JI4INKLER/DEMOLITION <br /> 41404 - CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATIO''. <br /> PROJECT SITE ADDRESS: 1 C0 1 -i rl f.2 �)e•, E(ii: 4515-0 13 PROPERTY TAX#: t O 7_.8D0.-7 q to <br /> LEGAL for new construction: Short Plat/subdivision ..--- _ No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Co 0144 a N V-t_L i 1C-dA I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 8 W U E../fr,1 IVi eLki Z • <br /> CITY L V VA-1."�-_ STATE -- ZIP f 8z-0 lJ <br /> OWNER PHONE: l"-3 33-.2...42....qOWN�ER/EMAIL:5 f ileti weic J 1-1;41 t SO1�.•r�Y11 <br /> CONTRACTOR NAME: eel L lc7 h,(faJ—6/� . <br /> CONTRACTOR ADDRESS: STREET <br /> CnY 5/14)/ /�� STATE4,„.1)4 <br /> )ZIP 106) <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED2. <br /> PRIMARY CONTACT: 0 OWNER. D CONTRACTOR t'J OTHER(Please Specify) etotlh:. rap <br /> CONTACT NAME: q� �J�/�� CONTACT PHONE: TO J‘. S-51. (,(O—S <br /> ��'c ) IJ"- CONTACT EMAIL: S trt,isi-t,u J.J e.,t Cti4,1.!vson• r(yiN <br /> BUILDING PERMIT APPLICATION ( -Cat)Existing Use of Building: Contract Price of Work:$ - _ <br /> Proposed Use of Building: • Heat Source: @Gas tit�Electric @Other <br /> Building Type: @SFR-Detached @SFR-Attached @Duplex @Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew @Addition @Remodel ❑Repair DT.I. @Sign @Sprinkler ODemolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> V' p(,•e --Z"eLtra A I CThtcloS <br /> ASSOCIATED BUILDING PERMIT#(if applicable): - - - - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 1(New_ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 'A/C—Air Handling Units Heat Pump (0 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air.Systems Unit Heater .2._. Bathtub Urinal <br /> '__ Gas Piping Boiler (p Lavatory(Wash Basin) Drinking Fountain <br /> i`,,. Water Heater Refrigeration 2. Shower Floor Drain <br /> ', Gas Fireplace Wood Stove Z. Kitchen Sink&Disposal Grease Trap <br /> 2 Gas Range 2. Ducting 9_, Dishwasher Roof Drains <br /> 7,_ Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> JRange Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> (Chemical orWater ' INo.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 296.20 WAC. <br /> City of Everett Official Use Only <br /> IOW <br /> Of PER IT# <br /> 1;x,7 ?,), 127:g—/7 ( v A� �� <br /> — 2. "- <br /> OwnerrAuthorized Agent Signature / Date (Revised 9/23/2016) <br /> )l� <br />