Laserfiche WebLink
PERMIT APPLICATIOEI I <br /> BUILDING /-MECHANICAL I PLUMBING I SIGN 1 SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECtf SITE INFORMATION <br /> PROJECT SITE ADDRESS PROPERTY TAX#: <br /> a ( Ave <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;CONTACT INFORMATION `�:. _ <br /> OWNER NAME: �( S GL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 619,22— FoJer Ave- <br /> CITY /� l� STATE � ZIP <br /> OWNER PHONE: — /LZ OWNER EMAIL: "O TSI CT2� <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: XOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> : <br /> - <br /> BUILDING. PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ,Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel gRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / pp <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLU,MBIN.G PERMIT AP;PLICATION:` <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 /> SPRINKLER SUPPRESSION SYSTEM;. <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.l am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /� PERMIT <br /> Owner/Authorized-gent Signature ate (Revised 10/12/2015) <br />