Laserfiche WebLink
ECT SITE ADDRESS: <br />PERMIT APPLICATION <br />BUILDINC#IECHANICAL / PLUMBING / SIGN �'RINKLER I DEIVIQLITION <br />CITY OF EVERETT PERMIT SERVICE <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 />LEGAL for new construction: Short Piat/subdivisio <br />PROJECT SITE INFORMATIORI <br />PROPERTY TAX #: C��(,� �7 <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: mG �- TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREEr fi�Si �i `c�t% 1'� _ <br />CITY � -r' STATE �v�-- ZIP '�'t �,S r�G 7 <br />OWNER PHONE: !'C_ L�L- � j�-�i OWNER EMAIL: <br />CONTRACTOR NAME, � p�f -.�. Ly„t -�" ;- _ <br />CONTRACTOR ADDRESS: srReer � L f �� �-V�P .(� � <br />GTY L� iV j�%'(N l�L"jD STATE �' ZIP �(� (�i� ... <br />CONTRACTOR PHONE: `�'Z_ -�j-= '/7S-Co ��Ln �� CONTRACTOR EMAIL: jJ' f2+{,q-,1,' G✓ j� 1,'Q /`i � j� �,LJ{�— <br />CONTRACTOR LICENSE #(REQUIRED); ���y�� " ` �{ L ,3 CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): � r�` � tl <br />PRIMARY CONTACT: ❑ OWNER /�CONTRACTOR ❑ OTHER (Piease Specify) <br />CONTACT NAME: CONTACT PHONE: �-( Z5- �Ci�- z�S�� <br />� C' � �,-�-r���' CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />ting Use of Building: Contract Price of Work: $ <br />roposed 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: /� /7� <br />��%L�CJC C.�C-L�jTC�/��''s t�/�-( V�l-T� GZ%iIT-P-/� ,�t"l�',1.�'1Ce^ y���')✓L ��% i <br />� 1 C� �' �lri-� {�� � �=r'Z � <br />< <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures Lisf of Fixtures Fixfu 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 Lisf of Fixtures #°f List of Fixfures <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: ����- .z ?q �;� rzvr "" <br />Sink (Service/Bar/Mop/etc.) Other: <br />�NOWLF_DGEMENT: 1 have reviewed this application and confirm the infonnation contained herein is true and co�rect. Work done pursuant fo this permit must comply with <br />nt federal, state, and local law. The granfing of a permit only aufhorizes approved worl< and no deviafions therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumsfance. l am the owne� or 1 am authorized by the owne� of this propeity to perform fhe work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />-- -� <br />CL�- � <br />OwneriAuf � ed Agent <br />1� <br />Date <br />City of Everett Official Use Only <br />PERMIT � � � � � D� <br />(Revised 10/12/2095) <br />