Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDI[ MECHANICAL I PLUMBING I SIGNIF: --JRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE=S <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> R �E <br /> QJ P <br /> PROJECT SITE ADDRESS: IPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> r1N.F <br /> -OIRMT ION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS. STREET <br /> CITY & STATE 4a� ZIP <br /> OWNER PHONE: OWNER EMAIL., <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET zza <br /> CITY STATE if= ZIP <br /> CONTRACTOR PHONE: 1CONTRACTOR EM.AIL: <br /> CONTRACTOR LICENSE#(REQUIRED): S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> Ilez <br /> PRIMARY CONTACT: El OWNER Z'CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /-w-"5- Z/ t L�L <br /> Le ICONTACT EMAIL: <br /> E <br /> I.T <br /> Existing Use of Building: lContract Price of Work:$ <br /> Proposed Use of Building: -Heat Source: OGas ElElectric ElOther <br /> Building Type: EISFR-Detached DSFR-Attached ODuplex E]Multi-Family-#of Units: ElCommercial ElInclustrial <br /> Type of Project: []New XAddition EIRemadel EIRepair EIT.I. ElSign ElSprinkler OlDernolition []Change of Use <br /> DESCRIPTION OF WOR , t - -J - <br /> t, /'N IA,) -T 1 <br /> t i E <br /> JASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL APPLICATION P,LU <br /> M1I G. PERMIT APPCI'CATION <br /> t M1t-APPL1rATION <br /> Type of Project: _New Adcln —Alteration _Repair <br /> Type of Project: _New Addn —Alteration —Repair <br /> #ofList of Fixtures #of List of Fixtures #of List of Fixtures #Of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling 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 /> Hood <br /> Water Heater Other: <br /> Range <br /> - Fan Sink(Serviceffiar/Mopletc.) Other: <br /> SPRIr <br /> N /_SUPPRESSLON SYSTEMA <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 graotingf permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building official before being authorized nder an 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/comply with the§tate C ntractor Law 18 7 RCW and 296.200A WAC. City of Everett Oft ial Use Only <br /> PERMIT# <br /> (Revised 1011212015) <br /> OwiertAu horized Nefent Signature Date <br />