Laserfiche WebLink
PERMIT APPLICATIOW <br /> BUILDIP-W-WECHANICAL/ PLUMBING /SIGN , ui RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROD GT SITE INFORMATION <br /> y.:{�� <br /> PROJECT SITE ADDRESS PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaYsubdivision Lot No. (attach copy of long legal description) <br /> . .. ...:.... <br /> :CONTACT'IiNFORMATI®N <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: / L <br /> CONTRACTOR ADDRESS: STREET <br /> 7 V-- CITY STATE ZIPLI" 0 C- <br /> CONTRACTOR PHONE: f L - ( - //CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): G G pjL �� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(J.S S_Cr t7 <br /> PRIMARY CONTACT: > 1 OWNER O CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: []Gas@Electric ❑Other 7 L <br /> ❑commercial ❑Industrial <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex OMulti-Family-#of Units: <br /> Type of Project: ONew ClAddition Remodel @Repair OT,1. @Sign @Sprinkler ODemolitiort ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 6� C 1 fi <br /> LfCATI <br /> MECHANICAL PERMIT APPLfCAT10N! <br /> PLUMBING PE':RMIT APP ON. <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project _New j`Addn _Alteration ,-Repair <br /> #of #of List of Fixtures #of List of Fixtures <br /> List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> 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 t 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 taw.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 I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> 1`3=4 <br /> Ow r/Authorized Agent Signature Date (Re1212015) <br />