Laserfiche WebLink
477 PERMIT APPLICATION ii, <br /> BUILDIItt I MECHANICAL/ PLUMBING I SIGN 1 SORINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> PROJECT SITE INFORMATION <br /> pan icr-r.crrF ADDR]rSS: , !AndPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Eut2 k:Q\ \Ackksyk� Pf �c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET'3VV1 C Cy\1y t 01.“2._ ( �� <br /> 1 crrvl3j (12.4 `'`l STATE �M1 6 ZIP YS•.11 �, 1 <br /> OWNER PHONE:2-tas 3-‘\' f)_ OWNER EMAIL: «! V` <br /> CONTRACTOR NAME: �0\\1(\\,13 `\tC,V\.��� - T(),\ 1.,C• <br /> CONTRACTOR ADDRESS: STREET 1:),t , l LnC) <br /> ,, CrlY6 &\G STATE \. iA . zip c--;,c91 L <br /> CONTRACTOR PHONE:Lvim.Q\O'5:r9 Li CONTRACTOR EMAIL:'t;"Se?CA.\ -\r'\c36.1(3 ,\ . (,C) <br /> CONTRACTOR LICENSE#(REQUIRED): :3�(ki 0 - CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): b5g31(r <br /> PRIMARY CONTACT: 0 OWNER NONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:.��, ` ,^.`\\\ Ck. A.s CONTACT PHONE: i �j•��G ��3�Li^ <br /> CONTACT EMAIL: �'i.,�-Y 4\cs V\,� CAZ:4 e CO AN_ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: (R % . 'C c-�\\\S c�= Contract Price of Work:$'7, C--,C`, -- <br /> Proposed Use of Building: 1 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex amulti-Family#of Units:Li pie-1, ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Q4epair ❑T.I. ❑`S1iggn ❑Sprinkler '❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:='eccp�_ VAD-TAA.c CA-° -tRSac 30'-1 C.• LakM1 4.4-C-CEL►.Q t./ \ IL, <br /> h %\ . S ? -< S\N%v.cyL \i \M'k(LC -' q,\\ 4.85ti S .+-.C, '�I-€� <br /> A-b s <br /> 1 -.4.6%S,%n5\0,3 is. J <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 /> NC—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 /> 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> (AA City of Everett Official Use Only <br /> PERMIT# <br /> AI0' -\\ - \S B(Srz-C <br /> Owner/Authorized gent Signature Date (Revised 10/12/2015) <br /> I's. 2 <br />