Laserfiche WebLink
• PERMIT APPLICATION <br /> ,14°). <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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (i.� 0 7 (2. ,'v�e,.�t..3tJO 1�1 PROPERTY TAX#: Z- O O3oo'f0 Z10 0 <br /> LEGAL for new construction: Short Plat/subdivision 06 Lot No.—Z9 (attach copy of long legal description) .1.1{44, gp' <br /> CONTACT INFORMATION <br /> OWNER NAME: S „,, ®g /u vas i A e_ TENANT NAME(If Commercial): J/ >f E"4 (2...-ii" <br /> OWNER MAILING ADDRESS: STREET 6,0') g.,) f_Qil )'At. � 4- ,y <br /> CITY ,.0'I.4„S/, STATE ZIP g '�_0 I <br /> OWNER PHONE: OWNER EMAIL: / <br /> CONTRACTOR NAME: r n...- �� ti17"'-- 4.--L_CONTRACTOR ADDRESS: STREET 50 o� L4) t 4 'Ia <br /> / � y��}� <br /> CITY 1t€4,J STATE C 1 ZIPS 6 es-7 <br /> CONTRACTOR PHONE: 1 ZS` 24)1 - 0 CI S� CONTRACTOR EMAIL: IAi �T M (tot_-��, clam <br /> CONTRACTOR LICENSE#(REQUIRES ycONTRACTOR <br /> C 1M A C.L. 1 Z£,B�Y OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 /O7 <br /> El <br /> 7 <br /> PRIMARY CONTACT: OWNER 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y2„5 - 7,01 — O b S <br /> rl V V! - P V'tA/0 Sr OnCONTACT EMAIL: On t� P 6._.... ,c, c 'M <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: UI.J 4 Contract Price of Work:$ it 0 ! ea 00 r CI' C3 <br /> Proposed Use of Building: W s �, Heat Source: as ❑Electric /❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-AttachedDuplex ❑Multi-Family-#of Units: _ommercial dustrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair 04.4 <br /> l. /❑�Sign ❑1Sprinkler ❑Demolition ❑Change of Use orc 5 <br /> DESCRIPTION: eve,, ui 0 3 0 `.4 Cs✓ 5 op <br /> ' IAA <br /> A�A�e <br /> pdActe._eat, pin,4.4s -4r- CAr lc 6 AlAifeliAtit— tAkSe <br /> 400 <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 #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 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 I 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 /> ,p (� �(�, r�iC 'p� (� � T City <br /> yoojf�Everett Official Use Only <br /> `''"'`M tAu 1 IL 't"VsLcc .1/ 1? �"?/O P '`�J'2 ' \.V — J L <br /> Owner/Authorized/ Agent Signature Date (Revised 9/23/2016) <br /> Pc wo r 012-12)Atk& L L (— Yt - <br />