Laserfiche WebLink
Min- PERMIT APPLICATION <br /> BUILDIN_JECHANICAL / PLUMBING / SIGFPRINKLER / 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:S OO�� Z3 rdAve) �, wit j (Da Q LiJ QcO2l <br /> V PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:(: ((?, "1"-1/4---1-6/a, l iD I it''/1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET�Q` S ��Ja t/^l/ <br /> / <br /> CITY �v Ci STATE ✓ l ZIP "/ 3 <br /> - <br /> OWNER PHONE: liZS OWNER EMAIL: Jefet-CO\1�w� 11, coat <br /> CONTRACTOR NAME: B lo L C.oI- (),l"/4IV <br /> CONTRACTOR ADDRESS: STREET P,0e • ,�CO? n <br /> CITY C Vej,JJ`��j'((� / STATE ZIP <br /> CONTRACTOR PHONE: (47..,c 3G --Z +Z..3 (CONTRACTOR EMAIL: S`I'eAie ,I (u, C c <br /> CONTRACTOR LICENSE#(REQUIRED) )01, nth ,Lc sr'j CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):©L4(PI I VI\ <br /> PRIMARY CONTACT: gWNER ❑ CONTRACTOR El OTHER(Please Specify) , <br /> CONTACT NAME: ��'' 1 CONTACT PHONE: LI' 3 .-c- <br /> 5 �(-00(,(4- ( ' � <br /> -Sq <br /> --Qera- (� //o1j��y CONTACT EMAIL: . 41'01 l0 I . 0 I i . IA NI <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: b-V._Atig_i 4 ,,CQ_ ,Cif) Contract Price of Work: $ ,..3_S I Cirr . `, <br /> Proposed Use of Building: 1Y ) <\ CI .e, f 9 cie,irt-Heat Source: as ❑Electric ❑Other <br /> Building Type: ,SFR-Detached ❑SFR Cached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (e,' , -c\focr- av\8 ._,e..:‘,\'‘, Ni\8, --C-\r-( 4\& Q_))(\ vv\IANP 6.6/V\JO. <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 /> 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> t • I PERMIT# <br /> j LQ 1110 I D�rD <br />,'1 n Authorized Agent Signature ate (Revised 5/20/2016) t'(� <br />