Laserfiche WebLink
I-u PERMIT APPLICATI® -r. <br /> 13UILDINL 16ECHANICAL.I PLUMBING 1 SIGN J VRIWCI_.ER/Dr-i OLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everattwa.gov/permits <br /> ffPROJECTSITEADDRESS: <br /> / T q TIE dNIFORWIA TI PA. <br /> i O C6 6t PROPERTYTAX : <br /> onstruction: Short Plaf/subdlv(sion Lot No. (attach dopy of long legal deserlptlon) <br /> OWNER NAME: TEPIANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET �` <br /> CITY (�CJ.��—,Q STATE �r/ ZIP S <br /> OWNER PHONE: OWNER)~MAIL: <br /> CONTRACTOR NAME: lam[=( i > ti a i <br /> CONTRACTOR ADDRESS: STREET at Zo �t L�- <br /> CITY — STATE WP zip ! l <br /> GONTRACTOR PHONE: SL�Zj -Z,52,- ,:5((4- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUiRED): <br /> PRIMARY CONTACT: EI OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (�ZS Jr©15 07ZZ- <br /> lLlr 1� CONTACT EMAiL: �p �S�YIGCac�_ <br /> ffExistlng <br /> AY'ION <br /> e of Building: ConfractPrice of Work:$Use of u[iding: Heat Source: Gas ❑Electric Mother <br /> Building Type-"MR-Detached ❑SFR Attached VfQuplex 'ult[-Famiiy-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel epair ❑T.[. EISIgn ❑Sprink[er ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK; 2, <br /> ASSOGiATED BUILDING PERMIT# if applicable): <br /> Irl Ul il�I® �lEf f�W.'A0PI�Mg <br /> Type of Project: —New_ Addn Alteration _Repair Type of Project: _New Addn A[tRepair <br /> °f List of.Fixtures ° List of Fixtures #°f List of Fixtures °f xtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toiiet Backflr(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinki <br /> Water Heater Refrigerafion Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Duct[ng Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer I Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ":: Rl<i�96` iLl �•% DIP Mpi.0.N, �R fl,,. . :.• <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 locallaw.The granting of permit only authorizes approved work and no deviations therefrom.Deviations must f/rst be authorized in writing from the <br /> Building Offfclal before being authorized under any circumstance,/am the owner,or I am authorized by the owner of this property to perform the work for which appllcatlon is made, <br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Oit1clal Use Only <br /> PERMITJ0 <br /> # <br /> DwnerlAuthorized Agent Signature Date (Revised 5/20/2096) <br />