Laserfiche WebLink
PERMIT APPLICATIO� <br />BUILDING / MECHANICAL / PLUMBING / SIGN I�t'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 � wv�v.everettwa.gov/permits <br />(Blue or Black Ink Oniy Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: :� � �' � j� �. PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: '�, �� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRES : sraeer t <br />CITY f '�/ � STATE , ZIP � L� <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME; -� �- � � � y� <br />CONTRACTOR ADDRESS: srrteeT � � � <br />CITY � � --," STATE ZIP <br />CONTRACTOR PHONE: U CONTRACTOR EMAIL: v -.�j I"" L T G <br />CONTRACTOR LICENSE #(REQUIRED): —�- - C S ��j � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): Q�� �j' . <br />PRIMARY CONTACT: OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � CJ� <br />�� ^r � .�� CONTACT EMAIL: .v ,�� ` ,�US �,.�G.�--Yn. ' t <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: <br />� a' <br />�'% ���,; ��� � �� �'� � j ��S�c �f r��� t 1 �n y�l�t �l�� � t�`/ <br />j(il s'.,CC� � 1il G� CG/7'/�c->C �ic%� �J�" �' <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fi�ctures Fi�ctures 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 _Alteretion _Repair <br /># of List of Fixfures #°f 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 this application and confirm the infonnation contained herein is true and cor�ect. Work done pursuant to tl�is permit must comply with <br />a�rrent �ederal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be autho�ized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or 1 am aufhorrzed by the owner of this property to perform the work for which applicatron is made, <br />and I comply with the State Contractors Law 18.?7 RCW and 296.200A WAC. <br />Owner/Autf�orizep Agent Signature <br />Crty of Everett Official Use Only <br />PERMIT # <br />.,;�-l� (�D`��'d�� <br />Date (Revised 5/20/2016) <br />