Laserfiche WebLink
Aw PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION . . . <br /> PROJECT SITE ADDRESS l�72 C6L- Y PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> , ,CONTACT INFORMATION ,. • .. <br /> OWNER NAME: 't:1JWt'r I.(C. !- ( H ar..stY(GB.* TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I- 2_1 /-....4.-L40,-.( A'1 . d� /� T t <br /> cITY ', ,Y� STATE WA ZIP -!�LU 1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: i',/ 65-f--t.., G_Oi -- 'T1Z�- - <br /> CONTRACTOR ADDRESS: STREET (62 `?,('') iqt,- `�'U( .TC. -1..._ L• j 4.1:3-r(; -3O6) <br /> CITy <br /> Y (z_ -i�l_, T.:� STATE 1rZIP �7�7 Jc. <br /> CONTRACTOR PHONE: 4-2e• .4-07 7'5'36-2- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): N`/S.NSLL(d)Ut`S� CITY OF EVERETT BUSINESS LICENSE#(REQUI D):D2 t' / <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR %OTHER(Please Specify) A- ..14 f`t Eczt- <br /> CONTACT NAME: CONTACT PHONE: (412-G") 2FJc:b D6±,47e> <br /> ' 1(( 4 i'ds.-1/.1.-to.i CONTACT EMAIL: Gje„Ylt'1 e.bnhart ki•Cdff <br /> . <br /> ;- ; BUI:LDLNG_PERMIT APPLICANTIO ' . . <br /> Existing Use of Building: L..E.,>tTA LA ' 2 Contract Price of Work:$ 401 DDD. OD <br /> Proposed Use of Building: R- 't-( , •2. Heat Source: ❑Gas DElectric DOther <br /> Building Type: SFR-Detached ❑SFR-Attached @Duplex ❑Multi-Family#of Units: 2Commercial ❑Industrial <br /> Type of Project: 0New DAddition IkIRemodel DRepair CT.'. DSign @Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: M( it_tro5latp 1:2_ 40v(4,vIE - -t-1. _, iz€,4vce5vA,t, <br /> A -t 7 ' ert-AGE:=NAr ' D_ G..0 Lv test., SW t-rcc-'(GF 'tz Sa_wrivc:t t'. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> -MECHAN.ICAL PERMIT APPLICATION':". PLUMBING PERMIT APPLICATON. <br /> Type of Project: _New — Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures <br /> List of Fixtures #of List of Fixtures #of <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. I am the owner,or 1 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# 4���� � 025L.✓' ./_ t a• 2D 1 <br /> Owner/Authorized 'gent Signature /7 Date (Revised 10/12/2015) 1 \ <br /> 1......, <br />