Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING ECHANICAL/ PLUMBING / SIGN LI�_RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICOL �b <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: `7-°s -5c= �VPt CG `� SU, X00 PROPERTY TAX#: ?t36¢/3o o�5v, 3&m <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Pc'f7 �C IJDNa/G� �✓Pdr'/'tin � 3CG[CTENANT NAME(If Commercial): Ze'&'�y� :. //";.r,it . <br /> OWNER MAILING ADDRESS: STREET SgS S.� / �/'�' 5���' r e -VC <br /> r'—VC 'y <br /> CITY Regi 7 STATE IV A ZIP V'SO,j L <br /> OWNER PHONE: Tom`S® 2 6 ,7 <br /> , s 9919 OWINER EMAIL: b;yt G, ele,k ;I:c 7 L� tool cos , /1 f <br /> CONTRACTOR NAME: 7-43-D (� S (.faj_e <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> i <br /> CONTRACTOR LICENSE#(REQUIRED): �155Gq ti CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ) <br /> PRIMARY CONTACT: OWNER CONTRACTOR >fOTHER (Please Specify) ✓C6v` L'C_� <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> c'�6rt G cex" 'rvn te® ,to <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ot!` l C e Contract Price of Work: $ c ®� <br /> Proposed Use of Building: of'yiCP 5 1,GP Heat Source: Gas Electric Other <br /> Building Type: SFR-Detached SFR-Attached Duplex Multi-Family-#of Units: YCornmercial Industrial <br /> Type of Project: New Addition 114Rernodel Repair T.1. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK: <br /> Cornbme S�v�1-c°5 /,00 �las"61 /v cvea-k lie,c.) 54,A- /XV, '40ve q f Sc>i3Ft' l os- <br /> to 6 e le afwceal y A t 1 �,-no/i` i oa► 4 e cal <br /> aG��,h'��s, Te/o rn><e /j j/i��,�, a�� �i.� ,`sfiPS• � <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 #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./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/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 /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Auth rized gent Signature Date (Revised 5/20/2016) <br />