Laserfiche WebLink
• <br /> PERMIT APPLICATION <br /> #ligi,/iti LIP ' 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: 4 1 2 5i +h t Ve i.e`1 '` PROPERTY TAX#: '17)i 0 26,02_ <br /> LEGAL for new construction: Short Plat/subdivision /-1 i,5h 1arid P1eftS Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: rgok inOrc, 1--a_an1(\p War ner TENANT NAME(If Commercial): n/ <br /> OWNER MAILING ADDRESS: STREET 41 2 5E3 4-h 5 SE <br /> CITY Eve r STATE (>J f\ ZIP 97 203 <br /> OWNER PHONE: LI COD5 IS I IOWNEREMAIL: r j S S W Qr ne_rl"_('ory\rf -i-. 1 v <br /> CONTRACTOR NAME: rl/1c <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: XDWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 1 lo ( , r r p,r CONTACT PHONE: At 25-7 )--/1 t5 1 <br /> CONTACT EMAIL: r j 5,5 war-ner'to o \c_0 4..iv_ <br /> BUILDING PERMIT APPLICATION <br /> ExistingUse of Building: 5 11'1 Contract Price of Work:$ 7 , <br /> �� �1711�l.l1 ��'�1(�nu_ �`x .9"' <br /> Proposed Use of Building: Sa yyV2_ Heat Source: , Gas DElectric DOther <br /> Building Type: ,SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition XRemodel El Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> upgr c&de- 2. ba5.err zn-}- W I ()do wS 43. w.rr\c w web <br /> 40 0 of res s 6 o ') i r3-1-a 1 I Kr d wa r (a c cQ ss 1:4 <br /> h +-c h ) PIA mP-u P 3115-I-e--m re r va i r biz1 ou3 rod e_. a -ole 10 hOLGQ ASSOCIATED BUILDING PERMIT#(if applicable): J <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 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit 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&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 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 l 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 /> L ���/ �� ���� ` I P- 1 (C-'ERMIT# <br /> 1g() oi I <br />