Laserfiche WebLink
0 0 <br /> _, PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION • <br /> Of"-A .--4. 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 /> (0lue till'.Black bale only.Ptease) . - . PR•JI CT SITE INFO 1ATiORI . <br /> PROJECT SITE ADDRESS: J 117 ez OC.L .t .r cz/t-- A`IC <br /> PROPERTY TAX#: ©0 kt 3d 23 LI9 ° dO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) I <br /> . .COtitAdt Y Po•kiydAT1till • • • • • • . <br /> OWNER NAME: 1A O/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /7.0, 0.. qv/I y �y <br /> CITY lJOCciri � y/a STATE / C ZIP l 66: 2_ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: E t.) .G(P-- AJ 6 -a-11C 6. 'C- <br /> CONTRACTOR ADDRESS: STREET °X II 2.-O (^ lctit AU t <br /> CIN EU 1 1 STATE till.- ZIP ie2)20( <br /> CONTRACTOR PHONE: 4`2-5-2-' 2-'3/It-F • (CONTRACTOR EMAIL: MAte1t e ecSMAlA .c.,aAt• <br /> CONTRACTOR LICENSE#(REQUIRED): e()G126.5S 0.2,2_0 T. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Z]6-1 ey j • <br /> PRIMARY CONTACT: ❑OWNER aCONTRACTOR 0 OTHER(Please Specify) - <br /> CONTACT NAME: CONTACT PHONE: 2 5 s 2-s2 s,/19 <br /> rl�� e F CONTACT EMAIL: Mp1211 gays,,,, A_cm- <br /> �I�IlGD11�I�P RtI�[IT APPLICATION <br /> Existing Use of Building: • <br /> ND (fl�a4tUG� I Contract Price of Work:$ t _ l`7 <br /> Proposed Use of Building: O �l Ic6� Heat Source: ( .Gas ❑Electric ❑Other <br /> Building Type: ❑SFR Detached C1SFR Attached ODuplex DMulfi Family of Units: iglrbmmercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair Oil. ❑Sign ❑Sprinkler CDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> R 0u b t dM«" z7 ToN RTJ, Ree(Ac 'vc-- e 0 6 eit -roA6.nmAt d fill ., <br /> II <br /> w/ 1 i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 114ECH.ANN1CAI.,PERMITi'APPLICAT1O i . - • . IPLUiv.i6i a i*Ekliiirt APPLiCATIOI! : <br /> Type of Project: New Addn __Alteration i Repair Type of Project: ^New Adds 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 f <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain M <br /> Water Heater Refrigeration Shower Floor Drain k <br /> Gas Fireplace <br /> • <br /> Clothes Dryer Hookups <br /> Range Hood <br /> Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Other: Clothes Washer Medical Gas <br /> Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. <br /> SIPRIf'iIKILIE I 01PIPPEPWi.19 SYSTEM . ' <br /> Number 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.lam the owner,or 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 18.27RCW and 296.200A WAC. <br /> n City of Everett Official UseOnly <br /> '% 0 3 f 9(`7,07zo IPERODC2O <br /> Y� 11 <br /> fixer/Authorize gent Signature Date (Revised 5/20/2016) <br /> 1//5 <br />