Laserfiche WebLink
1110 PERMIT APPLICATIO• <br /> BUILDING I MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: l o 3�f� ' I'l� ti P Il VVs ---verrtr- PROPERTY TAX#:007(CS00002&c'o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6 Iyni s 6 ray (( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /O3ACO q t- 11• CA (r <br /> CITY STATE V V ZIP 1 8' y <br /> OWNER PHONE: 725 ZZO "Z O 2_._ OWNER EMAIL: hf I f( <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: KOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lit j 22 O.-703 Z_ <br /> L / /LJf7(S r6fy CONTACT EMAIL: AfM. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: 'c7 Nl- r17 L'�cfke c v f.fi Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF.WORK: <br /> (�t{ 01 p-etc ►Cct C-zG�r'��S '(e a (,Ur °v 60"-°- c <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 Fi.. #of #of <br /> List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Hea • nip Toilet flow Preventer(Inside Bldg) <br /> Forced Air Systems it 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&Di sal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hooku.. Other: Clothes sher Medical Gas <br /> Range Hood Wate eater Other: <br /> Exhaust Fan (Service/Bar/Mop/etc.) Other: <br /> SPRINK R/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 of Everett Official Use Only <br /> PER' # <br /> ‘7° 7-,7 l5' Y&j9- -on <br /> Owner/ horized Agent Signature Date (Revised 9/23/2016) <br />