Laserfiche WebLink
PERMIT APPLICATION <br /> 'I0 <br /> /— BUILDIN dECHANICAL/ PLUMBING /SIGN fk—RINKLER/ DEMOLITION <br /> NII0 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: S ` �i1RO <br /> �11 1PERTY 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 ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> , <br /> CONTRACTOR NAME: R.e SC..0 c� <br /> L _Ck (� <br /> CONTRACTOR ADDRESS: STREET 05 v.....61/41 Rd 5� 5u k-c.. • <br /> CITY .. (11,6-1:' STATE �� ZIP 9664-7 <br /> CONTRACTOR PHONE: ¶ 3 g -LQg4 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ,` .ed'C..U` N 06 1� 1 � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O 3-7&,5(7i <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:1Q Ad z'dla CONTACT PHONE: ass q , Lts-ci 8 <br /> kJ� CONTACT EMAIL: a1 <br /> � ,J,.,t()6. I\ LD` (v\.rrj I, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas OElectric ❑Other <br /> Building Type: I:SFR-Detached I:SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial @Industrial <br /> Type of Project: ONew ❑Addition E7 Remodel DRepaii°r►► CIT.I. D1Signll @Sprinkler El Demolition UChange of Use <br /> DESCRIPTION OF WORK: ��kH atirkio IN ..‘eke..‘eke. (1C6l,Wq C A:L(1 OIvNd u)e- os e' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub .. Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> I 6^ovN') U,)aIL Paw <br /> SPRINKLER/;SUPPRESSION SYSTEM e1'o-it.1 <br /> Number of Heads <br /> ACKNOWLEDGEMENT,'1 have reviewed this application and confirm the information 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> - - _A, `1. 07 ‘- 11,0 tP( (ao4-ole) <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />