Laserfiche WebLink
• 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: q S - uc rz /'4all W2 PROPERTY TAX#: <br /> i E E"5-0 <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Cincii tio �rnav) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET OR 5 t xQ W ft l L, E- t 0 Q C� <br /> CITY t u�R f STATE }� A ZIP ' G Lo <br /> OWNER PHONE: 20L, - 3g3 - GLI Z3 OWNER EMAIL: <br /> CONTRACTOR NAME: SOi-C�`1Y1 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY w';)o .Q A STATE \/V.� ZIP 9$o 3-7 <br /> CONTRACTOR PHONE: 92-5- ­7-7 j -4?'3"'7 ) 1 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): SO UTH CP tc 30 2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ��pt- O rjo�� CONTACT PHONE: gZS- -7 '7 5 -737J <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodell ❑Repair t ❑T._I. ` ❑�SSign ❑Sprinkler El Demolition ❑Chang1e of Use <br /> DESCRIPTION F WORK: ,('Z,\ 'khS <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 /> 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:YZ, <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.l 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 /> PER 1)T�# <br /> 12- <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) r <br /> l <br />