Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDII'- MECHANICAL/ PLUMBING I SIGN RINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIGLii <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 l(E)everetteps@everettwa.gov I v,rww.everettwa.gov/permits <br /> eq <br /> PROJECT <br /> . ._.. .. . <br /> PROJECT SITE ADDS: PROPERTY TAX#: <br /> r <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .CONTAGT:INFOF. <br /> RMATIIONj. <br /> OWNER NAME: �(�Q�F TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Jy d �Y Svk\k <br /> CITY$Q(��� STATE v�►� `_,,ZIP� r� <br /> OWNER PHONE: OWNER EMAIL:LOv�� NI.a a So Qv <br /> CONTRACTOR NAME: (Y-)ETQSp <br /> CONTRACTOR ADDRESS: STREET )I - (� O�Q 1 <br /> CITY �•\ ( .S> STATE`10 1r 4 zIP `(1O'3J <br /> CONTRACTOR PHONE: �• ' S "�QS�- be�M CONTRACTOR EMAILSI�-\,-N�C. . C4NPO C 'T IUB <br /> CONTRACTOR LICENSE#(REQUIRED):(r�7#'J\% C4:, S 9,L- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL:Cr4�:1 R.`O• fl�st� C-0 (\(, <br /> BUILDING PERIVIIi•.A-PPLICATION -` <br /> Existing Use of Building: Contract Price of Work:$ �� <br /> Proposed Use of Building: Heat Source: EIGas ElElectric ❑Other <br /> Building Type: ❑SFR-Detached EISFR-Attached []Duplex []Multi-Family-#of Units: E7Commercial ❑Industrial <br /> Type of Project: ElNew EaAddition []Remodel EIRepair EIT.I. []Sign ElSprinkler ODemolition ElChange of Use <br /> DESCRIPTION OF WORK: <br /> vsrs'No\\ �y(�.1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> - <br /> '::'MECHANICAL PERMITAPPLIGATION _ : :.. PLUM NG MIT <br /> `APPLICATI ON. <br /> Type of Project. _New Addn _Alteration _Repair Type of Project _New ,_Addn Alteration _Repair <br /> #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures #Of <br /> 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 EJ Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER%SUPP;RESSI;ON::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.I am the owner,or t 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 /> Q 1 City ofEverett Official Use Only <br /> PERMIT# ! t 1 ;'V � � l•� '"�I <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />