Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDINL._alECHANICAL/ PLUMBING /SIGN / :INKLER/ DEMOLITION <br /> "1114SV/ --'—‘7. - <br /> CITY OF EVERETT PERMIT SERVICES <br /> 401W <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: "'"(-5--( l Cb a--IEL(� ST PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A(_C K( NA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Ev` .. - Db\}a `✓ ` <br /> CITY -v`47--E.-`T STATE V N. ZIP 9 b�L, _ <br /> OWNER PHONE: 4ZS– Et a–O OWNER EMAIL: y�P(b i'E Z.LC �'�' G t Al L,cuA <br /> CONTRACTOR NAME: eve t.....t_ �L: \-- �ta--K \N -( S (ik\1g-, Q %--'-b L 77 S--t(/-&. NC <br /> CONTRACTOR ADDRESS: STREET ` ._CLQ k.Ci\`LS j�' Sl", SU 1-TE ) S2/ <br /> / 1--,=NCITY i � 1 csSTATE V 9 ZIP jc.�"3CG <br /> CONTRACTOR PHONE: ZS -3 1 c,9 O,r i CONTRACTOR EMAIL: J,–l•tt' �C\it� �` <br /> e-i '-(-��J\(I NG t <br /> \16-N.J..CONTRACTOR LICENSE#(REQUIRED): \16-N.J.. k <br /> "r; -(BC1 j L..6, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 649 GDS-Q3 <br /> PRIMARY CONTACT: 0 OWNERCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: !I Z5j - 3' - t - C:31--1�e Cj <br /> f\/___,N M k-)Qcv_s i4t -Ltd CONTACT EMAIL: '-Nt r,C.E.,,,--_,_, F-,_,.,, -(EAT 11--/ , 6-4"V <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 4 D oc). co <br /> Proposed Use of Building: Heat Source: 'Gas DElectric DOther <br /> ❑ ❑ <br /> Building Type: SFR-Detached DSFR-Attached 0Duplex Multi-Family4 o Units: DCommercial El Industrial <br /> Type of Project: 1:1 New DAddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> .NC.Q L A.c_c. t I x`1(1–Lt— CCsfA`_a Ek.)9-hL A Com, (,J t T(-{ /L c .( <br /> C�tks f ��I`-L A Com., , <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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 1 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 /> 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 ar •ized 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 1 com ly ',the State ontractors aw 18.27 ROW and 296.200A WAC. <br /> n �_ City of Everett Official Use Only <br /> 1 LL,2_ti -- q ‘z_int, l 7 PE TI I S D <br /> ner/Authorized Ag. t S' nature Date (Revised 5/20/2016) <br />