Laserfiche WebLink
(Olerr • 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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or :lack Ink Only Please) PROJECT SITE INFORMATIO v . <br /> PROJECT SITE ADDRESS: 2--7 •7_ 0cAei e_ l PROPERTY TAX#: 6 oS 9 •3 66 3 n 16 Q <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Q„tit—(' Si_r:,,it;�(,� 12 b- --�--� TENANT NAME(If Commercial): C2 <br /> OWNER MAILING ADDRESS: STREET r7 9 12 i b VI 5-f 5-(.4--) <br /> -,1,n.v -P,- CITY STATE ZIP 9C30 5 <br /> OWNER PHONE: `/25 - Z1---61 3 O OWNER EMAIL: <br /> CONTRACTOR NAME: d "J ►ora' f,),00/ 'et ) <br /> CONTRACTOR ADDRESS: STREET 4(69/41 /3 '14 $i-Q 7 P <br /> ip p,nGT V p{ /t`P CITY I,� -- q !/ G- // STATE ZIP <br /> - <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ---).________) <br /> CONTRACTOR LICENSE#(REQI :rD M.0 4-q'Si_k CITY OF EVERETT BUSINESS LICENSE#(REQUI ED): 2,Ili <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR E OTHER(Please Specify) _.1 e• <br /> CONTACT NAME: CONTACT PHONE: -/ Z-.5 Z? q_'S'3) <br /> `J S/„� A Z l <br /> )n CONTACT EMAIL: -J E>�, b G-i T Fva0i�r�2av� 6g�� <br /> ' l/ /ram[ BUILDING PERMIT APPLICATION / (G'�l <br /> Existing Use of Building: 5e I P v eere= Contract Price of Work:$ 3c�,00/) <br /> Proposed Use of Building: -jam Y4/€_._ Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex ❑Multi Family#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair X.I. OSign DSprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> /In,sd-etk( .Z — , 4.tai-e-e 52,`te C <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION - PLUMBING PERMIT APPLICATION <br /> Type if Project: _New _ Addn _Alteration Re it Type of Project: _New Addn _Alteration R r <br /> #of List of Fixtures #of - t of Fixtures #of .'st of Fixtures #of ' of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C- ir Handling Units Heat Pump Toilet Ba ow Preventer(Inside Bldg) <br /> Forced A Systems Unit Heater Bathtub rinal <br /> Gas Piping Boiler Lavatory(Wash :: in) 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 D -r Hookups Other: Clothes Washer Medical Gas <br /> Range .sod Water Heat- Other: <br /> Exh.. st Fan Sink(S- iice/Bar/Mop/etc.) 0 •-r: <br /> PRINKLER/SUPPRESSION SYSTE <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 /> City of Everett Official Use Only <br /> 0 A...CA (4 <br /> OwnerIAuthorized Agent Sig ture Date / (Revised 9/23/2016) <br />