Laserfiche WebLink
��i���� �a�����i/����n� <br />C�UIL�I��V1�CH,�ilIICAL / PL.UM�ING / SIGP.... PRIMQ°CL�R / DIEiViOLITIOY� <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 />OWNER IVAME: 4� � <br />OWNER MAILING ADDRESS: <br />OWNER PHONE: �� (�._- <br />_ ._ ... _.-.......�.__,._., <br />CONTRACTOR NAME; / J <br />CONTRAGTOR ADDRESS: <br />STREET � (,i, <br />cirv ( A i <br />CONTACT INFORMAYIOt+D <br />TENANT NAME (If Commercial): <br />STATE ZIP G� L G' � <br />OWNEREMAIL: C (�'%'�"11��![SL��%r'� ilvJrbyl4'��• GC1� <br />CIiY �� � ' STATE /�V/OIt Z�p L1\/..1L; <br />! OL <br />CONTRACTOR PHONE: �"'� - l — v�� CONTRACTOR EMAIL: ' w�( �� , ��:✓ <br />CONTRACTOR LICENSE #(REC2UIRED): � L. `,11 � y CITY OF EVERETT BUSINESS LICENSE #(RE / IRED) <br />__. _ _ _ _.._ _ . __._ _. . _ _ .. .. _ _.. _ .. _ __ __. _ _.__ ___._....____ _ _ _._. <br />'PRIMARY CONTACT• � WNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: ' a CONTACT PHONE: �, r ��� -? C� � <br />� t. �C ��/�j�Gc/v� CONTACT EMAIL: u �/ ; G,� ,�y � [; - Lf1�--- <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 �emolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�f�''lG��r frc � <br />OCIATED BUILDING PERMIT # (if appli <br />'�?�-�-1�" ���G�(�T����. <br />ble): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fi fures Lisf of Fixtures Fixtures 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 SY�TEM <br />Number of Heads <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 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 fhis application and confirm the information contained herein is true and correct. Work done pursuanf to fhis permit musf comply with <br />current federal, sfate, and local law. The granting of a permif only authorizes approved work and no deviations therefrom. Deviations musf first be authorized in writing from the <br />Burlding Official before being authonzed under any circumstance. l am the owner, or l am authorized by the owner of this property fo perform the work for which application is made, <br />and l comply witl� the State Caiiractors Law >8.27 RCW and 29G.200A WAC. <br />City of Everett Offrcial Use Only <br />PERMIT� � � ��� <br />_ _ (Revised 5/70/2096) <br />