Laserfiche WebLink
PERMIT APPLICATION <br />BUILDIN�ECHANICAL / PLUMBING / SIGN �RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVIC <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.govlpermits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: "�� �� �����.?�� � t/L PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: J�jL f�L G�L�� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTrzEEr �i /� SCiu/'IC/ /T Tf�' <br />-�-{� /��(� /)� <br />CITY ��CiG/� STATE L4Jl� ZIP �Z/�C/_� <br />OWNER PHONE: ��� S d gG� ��j n OWNER EMAIL: �/YJ '�'�?� ,�;� G-�j c.��7'�%� c �Jy,� <br />CONTRACTOR NAME; /-h- � -S' �vY � _L✓JC <br />CONTRACTOR ADDRESS: sTREET j /(f v�"S�O�''� S/ lU� <br />CITY %�`�/i � .�j� STATE �� ZIP �� C � <br />CONTRACTOR PHONE: �6Q '`/p.5' �U5�7y CONTRACTOR EMAIL: C; i�j ��c>� L�' /J?Sr� ���rYY% <br />CONTRACTOR LICENSE #(REQUIRED): � ��f Q-3 �7� L CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):�.���YU� <br />__ _ _ _ _ _ <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: /) CONTACT PHONE: �? �<�b� OS'"%S� <br />// . � <br />��CP����� //��'�`j/� CONTACT EMAIL• �f.�� f�.j �� �G �/,!?S/7� GO; <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: /� S� Contract Price of Work: $ �� <br />Proposed Use of Building: 5�/%'� Heat Source: as ❑Electric ❑Other <br />Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />1���/1�� � �y '' u ��yrcx���=/� �'1J/� � ;�s /�i�r.� � ij.�c:�i <br />/c,�u,j,,Gt ��, c� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixfures Fixtures List of Fixfures <br />A/C —Air Handling Units Heat Pump <br />Forced Air Systems Unit Heater <br />Gas Piping Boiler <br />Water Heater Refrigeration <br />Gas Fireplace Wood Stove <br />Gas Range Ducting <br />Clothes Dryer Hoakups Other: <br />Range Hood <br />Exhaust Fan <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixfures #°f List of Fixfures <br />Fixtures Fixfures <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 informaiion 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 fi�st be authorized in writing from the <br />Building Official before being autho�ized under any crrc rostance. I am the owner, or l am autho�ized by the owner of this property to perform fhe work for which application is made, <br />and I comply with the State Contractors Law 18.27 and 296.200A WAC. <br />/ City of Everett Official Use Only <br />% <br />PERMIT # <br />� � �� � ��� -- � /� � �P �% � " �(� � <br />Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />