Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SFKiNKLER/ DEMOLITION <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 ar Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (�; � ��;��,y�i�� {��-� �,=��,�t�C ti�� �tS�c=-I PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �,V�• �;\" �-^,�,,v�+ TENANT NAME(If Commercial): <br /> OWNERMAILINGADDRESS: srReer � �� �`�"�,� �, ��-� <br /> n <br /> CIN �-.\;L.�L� STATE L^—�C'� ZIP ��(� �U � <br /> OWNER PHONE: 7� — �>� � � OWNER EMAIL; <br /> `-t� �" �' � � -�I 6`1`1 1����r C-c����,�t-f i,rL � � r�,<:,l. c�,� <br /> CONTRACTOR NAME: � - `�._, L,�\.,��t-. � <br /> CONTRACTOR ADDRESS: srREEr <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ,�I OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLIGATION "�� ' °� ' <br /> Existing Use of Building: Contract Price of Work: $ C �,� � ` <br /> Proposed Use of Building: Heat Source: ❑Gas- ❑Electric ❑Other,- '" <br /> -- . <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: �,,}� I� \�- <br /> S . l�l. 1) S U\1�i\ -�l� �'� C'.`.0 a� f�-kl;��Ibl(� �C�4' -\, <br /> C�t>s,�,� �?�.a t«_��� �-T �._>< <� � cs � <br /> � � <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 #�f List of Fixtures #�� List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtuies 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 8�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 /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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 a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial before being authorized under any cira�mstance.1 am the owner,or 1 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ` �' � P IT <br /> r� ; <br /> �—�— ` � <br /> �V�,�"�:-��� %�'�/� - I /;J��I � .�-. <br /> Owner/Authorized Agent Signature -� Date (Revised 9/23/2016) <br />