Laserfiche WebLink
� <br />� <br />� <br />� 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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �' �� Cj ►"'G' �� �(,�G'i PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />WNER NAME: ' �,�� �! (, 6J' TENANT NAME (If Commercial): S�t,f� j� '",u✓ .. <br />OWNER MAILING ADDRESS: � REEr � l 7j �j��vl_,1 ��j IQ VG2 /�� <br />CITY �(.,�i �' (1_��,.�� S ATE �C�J� ZIP C �� <br />OWNER PHONE: r' ` Q— �j ��� OWNER EMAIL: <br />CONTRACTOR NAME; 1,ciz..�_ ^l;) �(CiE7S C�� Q <br />ONTRACTOR ADDRESS: sTREET �! _ - c�i >: I�� 3 <br />aTv c � � �Z � / � �' srATE ��' �C'-L ziP � � � <br />CONTRACTOR PHONE: � Sr � LZ �Z7c� CONTRACTOR EMAIL: €�G%��R., , j�C .' � _� vr�� '� 2�' � CO(/ <br />CONTRACTOR LICENSE #(REQUIRED): � r2 �4.. � �� ITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �� , �Z— '�� � ,� <br />�._�'� � .S vz r G�� CONTACT EMAIL: � �G" ,L "�G � `� L%�- `�. �"C-� f / � o� . C <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 ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />r <br />��J '�.4V'L �'r���-�-�-,uP'�' G�`L-� ' 1`� SG/i�U c.v'�/�/i�4GQ �C���L� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteretion _Repair <br />Fixtures List of Fixtures Fixtu es List of Fixtures <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 Hookups 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 Lisi of Fixtures # 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: 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. 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,N omply ' h the State Contractors Law 18.27 RCW and 296.200A WAC. <br />! � City of Everett Official Use Only <br />� <br />C <br />� <br />Agent Signature <br />2� / � PERM #� � � <br />, <br />Date (Revised 5/20/2016) ��% i <br />v <br />