Laserfiche WebLink
�/��� <br />'I�w' : - <br />`,�.. � : <br />PEFaIVIIi APPLICATION <br />BIJILDING', ytIIECHANICAL / PLIJM�IN(;1 SIGN l�,e�RIN{�CL.ER / DEII�OLIiIOP� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 j(E) everetteps@everettwa.gov � www.everettwa.gov/permits _ <br />PROJEC7' SATE <br />PROJECT SITE ADDRE$S: � C� ..� , ��,��,�;;` ��r� PROPERTY TAX #: '�5� ' � ��� 9(` <br />c� �� �'�--� - f.�.�-�-� ��i' � �� -�.� --� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description} <br />�� <br />- <br />OWNER NAME: �� �C1'sf'�{ �. ��-.�d"�O%if3�c <br />�---- <br />n�e���eo nnnu iur_ nnnoece. ,._..��_ 111� .f <br />OWNER PHQNE: '', �� ` <br />CONTRACTOR NAME: �; <br />CQMTRACTOFtARDRESS: <br />CONXRACTOR PHQNE: <br />CONTACT 1NFORMtAYION <br />���` 6'�.�y TENANT NAME i <br />��N �_� U� � �'�- <br />�6���� <br />_ <br />��� <br />STREE� <br />CI7Y <br />CQNTRACTOR L.ICENSE #(REQUIRED) <br />C�'�.�'�- CLt�� <br />� <br />STATE LG� 8 9' ZIP J�� <br />OWNEREMAIL: tl � �+`�''� Ir"�.�t � ��d�` � �`'�`'� <br />STATE <br />ZIP <br />CONTRACTOR EMAIL; <br />CITY OF EVERETI' BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR � OTHER (Please Specify) <br />CONTAGT NAME: ��(„��`�� �' �.Q� � ��-� CONTACT PHONE: e-f � �- � �( � � ��( � � �-{Z,�' -S�( �{- <br />CONTACT EMAIL: i � ��'�,� ( �� � �i�i s � o ����� <br />Use of 8 <br />d Use of <br />BUIL <br />; �.���i't-� <br />� }`�'i � ' " � �'� <br />� �$FR-Attached ❑ <br />NG PERMIT APPLICATION <br />;��, Contract Price of Work: <br />��(� Heat Source: L►9Gas <br />�tex ❑Multi-Family-# of Units: <br />��; �� � <br />❑El�c#ric ❑Other <br />❑Commercial ❑lndustrial <br />Type of Pr0 ect: QNew ClAddi#ion I�Remodel �Repair ❑T.I. ❑Sign ❑Sprinkler C1Demotifion �Change of Use <br />DESCRIPTION O� WORK: 'i vl `'��-C�. I � Yk'�.:;�" �. r ���� ���� �r�,� � o '� '.� �� �l�' �c:�,,� �� � a ��� -� <br />.,C�.�f,; , A ' ; `�` <br />t�.� �: ��-'t��� � ��v�.a � �c� c�-# � �`'�%„��� ✓�.�� �' ra-' e �'; : , � a� � `�c�.c-s s; r � <br />�� -E (�f i� �' � e�4 S�' � 1 �i.S���- `�' i` 83-� � �'PI��S!���`�'-� , '�'�' ���` ���73"a�•a y -- i V'�'�� ��t�qr ��a�g� <br />�„e„i..Z.r � C.� s''� ' e � � /ir � c ��',c�%�,�;a '�', `�y��734-� �L'L-�/'�S '� �'--� �,.��A� i.��c'�- <br />6�� ��-� z�s�'�-e��.��� �. r S�'�.t� i,ss� rL��.cu;� � <br />ASSOCIATED BUII.DING ERMIT #(if applicable): �fic�,a.�u�- ��ps�C-����'-�� a�•!��-�'���''-'�'���� �� <br />MEGHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project� ,_,_New T, Addn _Alteration Repair Type of Project: New Addn �,Alteration �Repair <br /># of �,�st of Fixfures # of List of Fixtures # of Lisf of Fixtures # of List of Fixtures <br />Fixfures Fintures Fixtures Fixfures <br />A/C-Air Handling Units Heat Pump Toilef Backflow Preventer Inside B <br />Foresd Air Systems . Unit Heater Bathtub Urinal <br />Gas <br />Range Hoad <br />Exhaust Fan <br />SPRiNKL�R / SU <br />ON <br />4�itchen Sink <br />ftoof Drains <br />Other: <br />�D <br />� <br />��� <br />ACKNOWLEDGEMENT.� I have reviewed tltis application and confrrm the info�nation contained herei» is frus and correct. Work done pursuant to this permit n7ust comply with <br />current federal, state, and loca! law. The granting of a permii only authonzes approved work and �o deviations therefrom. Deviations must frrst be authorized in writing from the <br />Buildrng Official 6efore being authonzed under any circumstance. I am the owner, or! am authonzed by the owner of this property fo perfonn the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RGW and 296.200A WAC. <br />City of Everett Offcial Use Only <br />(t,j�L� { � P�RM1T #� • , , � �s ; �� ,' <br />� ,� � �i �--�.�1 � ^ 9 �� � ��.�. � <br />Owner/Authorized Age t Signature Date ' I I� (Revised 90/92/2015) °_ v <br />�i r - <br />