Laserfiche WebLink
4ffirPERMIT APPLICATION <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: /6,3 60th £7 5 E gwye? 1T LzJ f} PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: J a R P t 3-0(c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET)1/4.)3 y6O S T—SE <br /> err( f- <br /> Cn (J(Jere w,(�` ! If2 O STATE ZIP <br /> OWNER PHONE: y6" OWNER EMAIL: <br /> CONTRACTOR NAME: / Cf.57e'1Te r <br /> CONTRACTOR ADDRESS: STREET /9D/ 604 Te✓ 5 <br /> err( /c&viQ STATE / ZIP ?S 7e y <br /> CONTRACTOR PHONE: 253 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#REQUIRED T'P1.57 1 es %3/Q H #( <br /> : <br /> ) 7--2/5'7"' � CITY OF EVERETT BUSINESS LICENSE REQUIRED):6.S4f-LU6 <br /> �1C� <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) Prof/dcf-Ion Hoye-c <br /> CONTACT NAME: CONTACT PHONE:/ 3) 3 ,3- 28 <br /> 3-(95h Ala neer rrary CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> ExistingUse of Building: t t <br /> 5�,1 /,P . yv��-fc lr�5t��t ��- Contract Price of Work:$ <br /> Proposed Use of Building: 5c ' €_ Heat Source: 26as ❑Electric ❑Other <br /> Building Type: O'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 /> Ise-r0-0-IL <br /> Caster Lti LES-7 • <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 #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> r` c' 4-1 s l� io/� 131 101 <br /> OwrterIAuthorized At Si nat at (Revised 5/20/2016 <br />