Laserfiche WebLink
PERMIT APPLICATI( <br /> BUILDING / MECHANIC�+L/ PLUMBING / SIGN / SPRINKLER/ DEMOL1710N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SI E INFORMATION <br /> PROJECT SITE ADDRESS: L' ' � � � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long Iegal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ;> E � �__� zG� /' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRFEr � •,�j �� <br /> � /� , <br /> CITY �? �' STATE � ZIP �-�l.'� <br /> OWNER PHONE: ; ?•- ?�-� . � OWNER EMAIL: " j/�''� �_-ljC''pf E CG(L^L�< �'�" <br /> CONTRACTOR NAME: � >7 � � �l� 1 � 'j �Y7 <br /> CONTRACTOR ADDRESS: srReET � � � � G� �( r <br /> CITY � `' STATE ZIP ��a _..� <br /> CONTRACTOR PHONE: �(c"��—L — CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(R Q ED): S 2 <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONT�CT AME ; CONTACT PHONE: ���,, � �� - ,� '�� �.-�'� <br /> l��G �c �� ���12�G� CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION -- <br /> Existing Use of Building: <,�� (' ( � Contract Price of Wor .$ , � �C <br /> Proposed Use of Building: J��; C ��IL = Heat Source: ❑Gas ❑Electric <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑A di�o ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of se <br /> DESCFtIPTI ,rOF WORK: � C' �t,�G' /1CuJ� F'E� -�j�E4�'✓IS �l/1l� {7C`C�=� � G� /�[:` ,� / C' <br /> L�/1�������1�'l's` t:�� �'�rl�e- x �� c � <br /> h - ��`�� r�� �� �l,� f�> C-r�� ���� hc��,��� . <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 Fi�ctures #�f List of Fixtures #°f Lisf of Fixtures <br /> Fixtures Fix res Fixtures Fixtures <br /> A/C—Air Handl� g Units Heat Pump Toilet ackflow Preventer(Inside Bldg) <br /> Forced Air Syste s 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&Dispo I 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 /> S�ROId�SLE03/ $dDP�F3ES�0��! �l(S'�'EI!!E <br /> Number of Heads <br /> ACKNOWLEDGEMENT.I have revie�ved this application and confirm the informafion 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.1 am the ov✓ner, or I am authorized by the owner of this properfy to perform the work for which application is made, <br /> and 1 comply with the State Confractors Lav�18.27 RCW and 296.200A WAC. <br /> � , City of Everett Official Use Only <br /> .''��/' P E R <br /> � ����--___ /� �G v�0i .� ��C� C 2 - O�� <br /> Ow r/Authorized Agent Signature Date (Revised 5/20/2016) - � '.,�y <br /> � <br /> ,��.,,• <br />