Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDIN-41VIECHANICAL/ PLUMBING I SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.!jov/permits <br /> PROJECTSITE ..0 <br /> PRYJECT SITE ADD SS PROPERTY TAX#: <br /> LEG for construction: &4PI.t/subdivision Lot No. (attach copy of long legal description) <br /> INF RMAT.Ot <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET Ig C; VO V4 /h�/ <br /> OCITY R EMAIL: STATE L 14') ZI P q�PO <br /> OWNER PHONE: 7 <br /> CONTRACTOR NAME: <br /> V <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: ICONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(RE'QUIRED): <br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> ICONTACT EMAIL: <br /> -P <br /> -1113,UILD PERMIT APPLICATION <br /> Existing Use of Building: contract Price of Work:$--Fa b <br /> Proposed Use of Building: lHeat Source: E]Gas DElectric []Other <br /> Building Type: DSFR-Detached EISFR-Attached DIDuplex OMulti-Family-#of Units:_ ElCommercial E]Industrial <br /> Type of Project: ONew ElAddition DRemodel EIRepair CITJ. E]Sign ElSprinkler ElDemolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> 1/Z <br /> 11� <br /> fASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL.-PERMIT-APPLICATION -PLUG MSINPERMWAPPOCAT- 1106111 <br /> Type of Project: _New_ Addn —Alteration _Repair Type of Project: _New —Addri —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 /> JRange Hood Water Heater Other: <br /> JExhaust Fan Sink(Service/Bar/Mop/etc.) Other: <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 local law.The granting of 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> Signature Date (Revised 1011212015) <br /> O,w...lA.thd 4ized gent�SL �1) <br />