Laserfiche WebLink
4En- PERMIT APPLICATION* <br /> BUILDINGOECHANICAL / PLUMBING / SIGN I FRINKLER/ 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: /7i-0 M /S'2,J g7. PROPERTY TAX#: (O405 f'St1L O000070Z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f (D Jg if. 14-,E.i 1._P 1 AA1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (7 4-0 Pi A-Di Baal 57 <br /> CITY V4`-2g,7Y STATE w4 ZIP q g Z03 <br /> OWNER PHONE: 425-s 551- 1 9 OWNER EMAIL: ,J ll�t I rhotiq S7 € y ihnO.C•vw, <br /> CONTRACTOR NAME: 0 kiliV <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: El OWNER ❑ CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4zs'_ 3 55-" 1zpi9 <br /> `V W 1 LA411.0 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ `' ? 2. E, <br /> _Proposed Use of Building: S Heat Source: El Gas Electric ❑Other <br /> Building Type: IXSFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New Addition El Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: A sG Sr. U JV /L g_x!STiiva 12OF <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Ty�p f Project: _New _ Addn _Alteration Repair Type of Project: _New _Addn _Alteration Repair <br /> #of \ #of #of\1 #of <br /> List of Fixtures List of Fixtures ,, List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures '-. Fixtures <br /> A/C—AI andling Units Heat Pump Toil\\ Backflow Preventer(Inside Bldg) <br /> •Forced Air S tams Unit Heater Bathtub Urinal <br /> Gas Piping `--, Boiler Lavatory(Wabrkasin) 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 er: 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.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!comply with the State Contractors Law 18.27 RCW and 296.200A WAG. <br /> City of Everett Official Use Only <br /> / // PERMIT#cc?: ,v.......4(.. _ 0 L c--,1 <br /> YZZ: 5/27/0 <br /> Owne •uthi zed Agent Signature Date (Revised 9/23/2016) I/' <br /> f> <br /> /`--- <br />