Laserfiche WebLink
_ -- 410 PERMIT APPL ICATIO• <br /> ,�. �!, BUILDING / M �L( HANK AL. / I IL UhIIBINC:; /SIGN / SPRINKLE[ / L) IVIiOP�_.I'll ION <br /> W ��� _ CITY OF EVERETT PERMIT SERVICES <br /> ' ` `'� ,Fier 3200 CEDAR STREET, EVERETT,WA 98201 <br /> =- (P)425-257-8810 I FAX 425--257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blare or (Black link Only Please) -- PRCJIECT SITE INFORMATION— -- 1 <br /> PROJECT SITE ADDRESS:(011. 1 _ /9 ''? • ci. I 41,f PROPERTY TAX#: 'le Ar2 Zo3 Tvzi <br /> LEGAL for new construction: Short Plat/subdivision __ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (vV4', , 4'/Af tit 7)4' -WOO TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /b3o q J k- 71' J7/'2.ee-7, <br /> CITY B�+LL056"v e- STATES pt.,. A.' ZIP ?god 6 <br /> OWNER PHONE: - OWNER EMAIL: t ri et q (t,8 vi t,...,0 vs3 e,put 4 1 • CAO7s, <br /> , <br /> CONTRACTOR NAME: 'r .j _v, <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ( -OTHER(Please Specify) A--QZC't-{ (? .'C Tr <br /> CONTACT NAME: t2.a5 -' LT-Ant t eS 41•46 CONTACT PHONE: C4-v3-) 2 S Z - • 2 f )3• <br /> -2--e2 j.--2 k2-C-Ili -Ter( (tJp - CONTACT EMAIL: ►--•SS Q.. till <br /> f 1 c 4-c t..+'t-C?-(a 1 C. .Ce. <br /> BUILDING PERMIT APPLICATION <br /> 1 <br /> Existing Use of Building: S I all be ere- ,•a-e c t.. _ Contract Price of Work:$ <br /> Proposed Use of Building: T 0 e— Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached O'•tiFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition DChange of Use <br /> DESCRIPTION OF WORK:!4 PiturvJ €"07_ j2_ vJV I 1.-4:)w & tia . s'1 Cori t 1.$.+ <br /> L.A....--/ j s 0 t t,i t7 tr¢-{`_ r e-'a AA ( r, rc.. it. -t._.4-t v.N C 7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): kit Z- lit'ld4rVS <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> UM A ION <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn _Alteration Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 'L Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems / Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler 2. Lavatory(Wash Basin) Drinking Fountain <br /> / Water Heater Refrigeration I 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: I Clothes Washer Medical Gas <br /> / Range Hood 1 Water Heater Other: <br /> 3 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water O 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 /> PERMIT# <br /> la) <br /> OwnerlAut orized Agent Signatu'e Date (Revised 9/23/2016) <br />