Laserfiche WebLink
Ojerr • 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 Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4il3i S E.AV 16W WAY PROPERTY TAX#: 00 5((1 9 00 4 00 203 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: &_,O C7 hO/`1 � r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 22 (/ c7) 1,(/�i'((l%i u)A' NG- Cr--- <br /> '(P <br /> CITY c (,c,i-v0 fi- STATE ZIP <br /> OWNER PHONE: 20(y--Gj'7q( — ( O03 I OWNER EMAIL: 5(,p-(/'(@ c4(2-job G,kUPp,,,=AL'(;! God( <br /> CONTRACTOR NAME: f t,p---6rj-t 1k4C-T-Lf3W -- !1 V&t1 t(r S /iVC/ C?(//r- - <br /> QQpIi.ca <br /> CONTRACTOR ADDRESS: STREET �f <br /> CITY lam: STATE (.^JA ZIP <br /> CONTRACTOR PHONE: m - , ; CONTRACTOR EMAIL: . <br /> CONTCA AJ V(--' D r . . , ,ar �a„ , -x <br /> ACTOR LICENSE#(REQUIRED): ,r - ..7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR LK OTHER(Please Specify) .. _ , A7R.AcA,L7r <br /> CONTACT NAME: �,, (` CONTACT PHONE: 2 ( -4'Z-t 1 t 1 <br /> T` JCD�tr(S? CONTACT EMAIL: A(.„,15..7( Yf_- 0E-5,(�I4'7 ,_ „ <br /> rr BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S rrQ- Contract Price of Work:$� OUC) <br /> Proposed Use of Building: 5ra_ Heat Source: KIGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached IpISFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition Oil Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: vkp,t4O r(4uAgDRZP(e5 'tO gg... (SR.oVCtNt -co cow.:ZFri AWfN(..1 &J 6 to f3e- <br /> N1oAIFt6.o, MQ.A4AN1(Al, VO P - / zeSUPPor-ZEo/ R,EPI.A(tp) ) (.tt- Po575 io 6z- <br /> M O D I I t.D/ a4-1'LACE.. <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 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> Gas Piping Boiler (9 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration Z Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> ' Gas Range Ducting 1 Dishwasher Roof Drains <br /> t Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> 1 Range Hood Water Heater Other: <br /> 4 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 Co actors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 5/7((g' �w /gO� �DDI <br /> Ow er uthor(zed Agent Si nature Date (Revised 9/23/2016) -`. <br /> / <br /> / 1 / <br /> / 2 <br />