Laserfiche WebLink
PERMIT APPLICATION <br />BI R / DEMOLITION <br />BUILDING /MECHANICAL /PLUM PLUMBING / SIGN i SPRINKL <br />CITY OF EVERETT PERMIT SERVICES <br />• 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 ( 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: %b <br />�, <br />PROPERTY TAX #: DD (00h I CVW 790 <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME 0 C.; a n� <br />OWNER MAILING ADDRESS: STREET A.If It <br />Vr- <br />CITY <br />STATE WA <br />ZIP d <br />OWNER PHONE: Sw — 4 v i <br />OWNER EMAIL: <br />; <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />(AN 0 - - ( ITy <br />STATE <br />21P <br />CONTRACTOR NE: •- 97'' j <br />CONTRACTOR EMAIL: <br />t, <br />CONTRACTOR LICENSE #(REQUIR 1,.. <br />Q <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: `OWNER Ej CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />' <br />CONTACT PHONE:.31VD„ ., <br />CONTACT EMAIL: b i s ' l • �D <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />lContract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric <br />❑Other <br />Building T e: ❑SFR-Detached ❑SFR-Attached ODu lex ❑Multi-Famil # of Units: ❑Commercial 01ndustrlal <br />Type of Project: ❑New ElAddition ❑Remodel ❑Repair <br />❑T.I. EISi n EIS rinkler ❑Demolition <br />❑Change of Use <br />DESCRIPTION OF WORK: <br />Z)e mO OP G4 P-" a q- Leve-1 s,tj g o� 6l ek4A" <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New ,_, Addn Alteration _Repair <br />Type of Project: _New Addn <br />_.,Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C -Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />INIo, of Heads <br />ACKNOWLEDGEMENT.• 1 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 /n writing from the <br />Building Offtctal before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application Is made, <br />and 1 comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br />CV of Everett Off/cial Use Only <br />PERMIT # <br />t-Io oo� <br />(Revised 912312016) <br />(00 <br />