Laserfiche WebLink
PERMIT APPLICATIOh <br />BUILDIM�! IVIECHANICAL / PLUMBING / SIGN , UI 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 />PR ECT SJTE ApDRESS: PROPERTY TAX #: <br />_ `_� d > >'' i `��'( `�y., �V..'��' � ��� � l�� ��ji �i�:� z_� ��ii`��) r. �'ii ) <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �j-{�� v, �� {��,cy�� j � '�' � <,. �.� TENANT NAME (If Commerciall: <br />� <br />OWNER MAILING ADDRESS: srReET ��^ �� �' j�1 j � �Z�J <br />ciTv 4, <br />STATE '�,� ��� ZIP <br />OWNER PHONE: `{Zj - � J - �!� t.�C'j OWNER EMAIL: _ �j ;�-� >; �'� �J ' Z � <br />� <br />CONTRACTOR NAME: „� j>, Y�e C_. �� �'i 1'�)�L� � iT � 'I�r � � �<)c_. <br />CONTRACTOR ADDRESS: sTReeT � � j �� C-� ���y� � �� <br />�}, �.� CITY �� �l STATE � � { � ZIP <br />CONTRACTOR PHONE: �j'� - ZZ� - Z�c7'f CONTRACTOR EMAIL: �� �.G', ,? � .- � . '� ;�> ,��.' E j,� ,,., �� <br />CONTRACTOR LICENSE #(REQUIRED): � S � Y1 � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �,e:Z� _ ��� _ ,�-�� <br />Lo.ii�'C�_ �'`'���=��+a CONTACTEMAIL: ' ; ,�<-- <br />� �,�� �- �. ����:. � �,rinxi+�Sl;� +l �r".� .. n:. <br />BUILDING PERMIT APPLICATION <br />Existin Use of Buildin : � ��' � <br />� � Contract Price of Work: $ ��r') <br />Proposed Use of Buildin :��� � Heat Source: ❑Gas ❑Electric ❑Other <br />Buildin T pe: �SFR-Detached C�SFR-Attached ❑Duplex ❑Multi-Famil -# of Units: ❑Commercial ❑Industrial <br />T e of Pro�ect: ❑New �Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: <br />(\�c4 �-11?1 %T� dN j�i'� `-�� �a"-i :� �,�, <br />�ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bld ) <br />Bathtub Urinal <br />Lavato (Wash Basin) Drinkin 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 con�irm the info�mation 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 I am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Ciry of Everett Official Use Only <br />� PERMIT # _ <br />�,�-������ t�/ �'�% il� ��� '(�� r � <br />Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />��z <br />