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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �� ',;Qiz � ;'�/�'1`� PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: L �.� TENANT NAME (If Commercial): <br />OWNER MAILING AD RESS: sr EET , d� �'(� - <br />CIN . ,.,� �� STATE � ZIP � �i 3 <br />OWNER PHONE: OWNER EMAIL; <br />CONTRACTOR NAME: �L c�� / :Q '�� �' �' �. ' <br />CONTRACTOR ADDRESS: sTREET � r, �_�• � � r <br />CITY . �; � STATE �Y% � ZIP � <br />CONTRACTOR PHONE: ,�j •- j- t-� —� ZJ' I CONTRACTOR EMAIL: ����,�—: C%� .Y� � ' l' . , Cp/�7 <br />CONTRACTOR LICENSE #(REQUIRED): ' � G� 4 � CITY OF EVERETT BUSWESS L ENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER Cy CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �� ., 5 7� (�- .— S� D <br />CONTACT EMAIL: �. � . � 7 - y <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: yt ���� �� i l u�i� �G�r .�l�y`� , G�•GL Gl���� <br />N � �� <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 Lisi 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: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <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 theref�om. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or l 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 />i // ! � PERMIT I� ` � `,�' O �� <br />� V <br />� <br />Owner/Authorized Agent Signature ate (Revised 5/20/2016) <br />II� <br />