Laserfiche WebLink
�^ �f�6'��,�tl�"U"�P��.9C��'IO�G <br /> .,, <br /> f����N���9C9 / G!l��CF9��91��P�/ V'������I�� / 5��4� /�C�G2�i�G����/ ���!l�0�9TI 9�1� <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� �wwd.everettwa.gov/permits <br /> Q�Vaa� �o-�0��� �ov�C�uv�}� P6����� �[������i'�D�i'� ��9��f1�V�9iL�lll O�R� <br /> PROJECT SITE ADDRESS: 22 � �/�Q_ PROPERTY T�,X#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ��Ge��'��5'1 9 G�N G��9�Gi�L�'�'0��'1 <br /> OWNER NAME: /,� � �. V- �� •� TENANT NAME(If Commercial): <br /> OWfVER MAILING ADDRESS: s-rREFr � �� �e: � �jl, (� <br /> cirr ��J�'1��C 1�1� srnTE L�1 riN ��� , <br /> OWfVER PHONE: �, '� '" ��7 j ^ /f r� OWNER EMAIL: t,.�l'" 'Lr�{� � J� C, C�UI-t"/-t • O'�CG� <br /> CONTRACTOR NAME: �_ C�t'C'S C» - C <br /> CONTRACTORADDRESS: sTRE�r � ��� ' �j;r�p ��-- � �. <br /> Cfi`( /t,.. C�,I U� STATE � �� ZIP �3�� Z <br /> CONTRACTOR PHONE:� S�� — d�`]3•- U ' � CONTRACTOR EMAIL: _ � c,�e g C`c;��'� ,� LL..0 • C-G V✓� <br /> CONTRACTOR LICENSE#(REQUIRED): �r 1��!�L-f G�S �Q CITY OF EVERETT BUSINESS LICENSE#(REQ IRED): ( : ;, ;� ;"- y,, <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � � ,_ L�� �-Q��� <br /> � �C t S L@% 2 CONTACT EMAIL• �i1r� 5 C �J���S �c��;�l� L.�C.e.,f�i� <br /> BU9LDIPo1G PERM1`9°�PPL�CA'9'IO1V <br /> Existing Use of Building: � Contract Price of Work: $ ���(�� �� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: 'SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /� 1 <br /> ��.t�'G�� 0'tS'17 r�G� I 'I V ��sV�G�� �. <br /> � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ilIIECB�A9d9C/�L PEBtMI'i'APPLICATIOT7 �LUMBING PERMST/�PP�.9�A1'ION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisf of Fi�ctures #�f List of Fi�rtures #�f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fi�ctures Fi�cfures <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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> 5C�Y216�9��EFt/ SaJI��RES�90� ��'S'T�IVI <br /> Chemical or Water No. of Heads <br /> FlCKNOWLEDGEMENT'I have reviewed this applicafion and confirm the information contained herein is frue and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and loca!law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> IIuilding Otficial before being authorized under any circumstance. I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI <br /> �. a � �OS — �� <br /> �fr�' �� ��;,-- <br /> wner/ horized Agent Signature Date (Revrsed 9/23/2016) <br />