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 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />' PROJECT SITE INFORMATION ' <br />PROJECT SITE ADDRESS: , PROPERTY TAX #: <br />.b Lia Fs.-�t: ft� Jz ��.Id��N' �j <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION ' <br />OWNER NAME: C�uvv� �;tij^ µZ�• j � ��� TENANT NAME (If Commercial): (�j�� ��jj TQ � f.�f,�j <br />OWNER MAILING ADDRESS: srREEr �L� 2� �a�2,� %� �/� <br />cirr .�(% sTaTE � ziP �� �El <br />OWNER PHONE: L) ' S- �`'I� -(�ZOQ OWNER EMAIL: (;r�QY, Liu[�r,�}AJ `=JL��+n ,aSS i-�, U� <br />CONTRACTOR NAME: � 1.e,� �r�';,:� St' V� <br />CONTRACTOR ADDRESS: srREEr � (>�,l �u: J!'(1 �y✓2 � <br />CITY � 7 ��.-� � � STATE ZIP � �� � <br />�� . <br />CONTRACTOR PHONE: (p � �J Z� - S `"� �(� CONTRACTOR EMAIL: /�� �+/�sik�r ?J te��-�;� rr�� , ut .[:�,v1 _ <br />CONTRACTOR LICENSE #(REQUIRED): � L'�F1j ��QJ b F� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):�Y�-�� <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: � CONTACT PHONE: 'L� - j ZZ -�'j'�3(� <br />/ `�iYl/U lX��/IGI��% CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: �` �' •• Contract Price of Work: $%`�� `` �C� ,�V <br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ommercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: Q <br />f1f:JV��✓�, �i51�1�1%(� LOYVI�C`>����l�✓ ���l�i1c���� ��d r�Pr'��e W'� <br />� <br />�iI�Q. li��le�l �l�S- <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 #�f List of Fixtures # of List of Fixtures # of Lisf 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: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correcf. Work done pursuant to this permit must comply with <br />cunent federal, state, and local law. The granfing of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Officia/ before being authorized under any circumstance. I am the owner, or / am authorized by the owner of this property to pertorm the work for which application is made, <br />and l comp/y with the Stafe Contractors Law 18.27 RCW and 296.200A WAC. <br />��17-�.� <br />Signature Date <br />City of Everett Official Use Only <br />PE MIT# <br />l 5 - G.� <br />(Revised 10/12/2015) <br />