Laserfiche WebLink
OLTPERMIT APPLICATIOI <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: :50 ? C.{,d. ?i iii G'IA+. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 10 gAtli0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRES : STREET r Nr7 C11.42,1- S'-E- ` ' l f <br /> CITY /,Le� STATE W4 ZIP Sy� <br /> OWNER PHONE: _v` OWNER EMAIL: Q <br /> CONTRACTOR NAME: 114 <br /> 0 50/, c(f P_ /4.,(---- <br /> CONTRACTOR <br /> 4L(jCONTRACTOR ADDRESS: STREET Vgi?..,(p .7Lel ip/.,, &) 6 <br /> CITY ( sU a.-t 1,•-! STATE w 4- ZIP Q Q���� <br /> CONTRACTOR PHONE: G{�Gj�L(c�— (i`(°�?j CONTRACTOR EMAIL:Ntagd�•e,Leol-F,(t'_ ( c µtai( .cv✓w <br /> Kaon(4. nQR . ..(RE .. <br /> CONTRACTOR LICENSE#(REQUIRED): �g P� O(� CITY OF EVERETT BUSINESS LICENSE#REQUIRED);ty5it 54 I <br /> PRIMARY CONTACT: ❑ OWNER I ,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(4 2...g...3 Ltc-_4 Cs 3 IS <br /> ® „�5,-,ck aS01 - CONTACT EMAIL: �rd so.. e,le,e4,f,(_ ,,s--,9 (�c�� r O►ti. <br /> �"' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: (ZeStsj,.frte,,_ Contract Price of Work:$ 1,2..C?7 <br /> Proposed Use of Building: L. Heat Source: f$3as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached El SFR-Attached ❑Duplex 0 Multi-Family4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel VIRepair ❑T.I. ❑Sign ❑Sprinkler ❑Dem olition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Lu vr, 8sp,--c,2,( e— Rtipa.r bat], w-r- .A. . <br /> r� <br /> Rep iv 4,�t,Gl• P <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 #°f List of Fixtures #°f 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 FireplaceWood 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I 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.I 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 /> �Ciitty�of Everett Official Use Only <br /> af,,di.-v40 PFT `-' I U O 4-- <br /> Owner/Authorized <br /> Agent Signature Date (Revised 5/20/2016) <br />