Laserfiche WebLink
PERMIT APPLICATIO <br />BUILDIN�MECHANICAL / PLUMBING / SIGN / RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: G��� �„�,��� �� Sr, PROPERTY TAX #: �;cr�-�C�,�,r_-?�-� ��p 1' <br />LEGAL for new construction: Short Plat/subdivision Lr-^ �'�� �-�' ��F�''� ��� �� Lot No.�y' (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �� �� � ��-N ���'•� ���'�� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREET y� v 1 L��"✓� �� �l--G S�E� <br />CITY r["i�'�"����� STATE ���° ZIP a F"'��.7 <br />i� _ . '1 t , G : �f <br />OWNER PHONE: L_� y t'� 7� u n OWNER EMAIL: <br />coNTRacTOR NannE: � !�G !� r�,�� l� � N��'�lv� ✓;�J'�.-t,��'f_.-E-5 <br />CONTRACTOR ADDRESS: srREEr '�;=�,� /!/�, F J P.I ;;�� <br />CITY .�I�r-L��� STATE �'�'! ZIP L+ �� i` <br />CONTRACTOR PHONE: � �s J � � � — 3 � � <br />f ( c.. E r W G� CONTRACTOR EMAIL: ��•t ��0� S�, /',Jt �.G.�/J<I�.L j/ „�. �(tqCa� (,!� <br />CONTRACTOR LICENSE #(REQUIRED): �c'( N��'F S�a�%�-1 � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): lJ��S:— <br />PRIMARY CONTACT: ❑ OWNER „�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: j� 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 ❑Remodel ❑Repair i�T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: i,,�;.,�� r-�l�/ i� /� �'J� �✓ C��� ���---{-���� ¢'Y'r+s'r /�'L ���.� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fiutures # of List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is t�ue and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local /aw. 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 au horized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State �actors (�'�✓ 18.27 RCW and 296.200A WAC. <br />City of Everett Officral Use Only <br />'" PERMIT # <br />� � l -�i--1� � ' � �� L <br />i Date (Revised 10/12/2015J <br />