Laserfiche WebLink
PERMIT APPLICA710N <br /> BUILDING / MECHANICAL/ PLUMBING 1 SIGN / SPRINKLER/ DEMOLIT'ION <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 SITE IPIFORMATIAN <br /> , '�� <br /> PROJECT SITE ADDRESS:�-.� I �` U� '�Chv l�V �� ��� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> � <br /> OWNER NAME: � r y " `E�' TENANT NAME(If Commercial): <br /> OWNER MAILWG ADDRESS: srrtFET '-�'�j)�'rJ <br /> � <br /> CITY r t�J, STATE ZIP �_� <br /> OWNER PHONE: �� 7 OWNER EMAIL: �e1(�I}• �')U I Y ��.S ��Q-� C,�/7 <br /> CONTRACTOR NAME: G � � � <br /> CONTRACTOR ADDRESS: srReeT �� <br /> CITY � �� STATE ZIPC,�� �� <br /> CONTRACTOR PHONE: 3 ��1� CONTRACTOR EMAIL:[.:t, �" �-�- � , /�c, ' �C )U�. C�'1 <br /> CONTRACTOR LICENSE#(REQUIRED): Lm�CL J� 7 CITY OF EVERETT BUSWESS LICENSE#(REQUIRED):�5�f <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <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: <br /> �-e Y�� <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 Fixfures #�f List of Fixfures #�f List of Fixfures #°f List of Fixtures <br /> Fixtures Fixfures Fi�ctures 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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ���o����ma i�u���a�s�oo�a sv�-��� <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have revrewed this application and confi�m the information contained herein is true 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 /> Building Official before 6eing 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 I co�nply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> lI City of Everett Official Use Only <br /> \V_—w_-:�:_–_ ___-------- PE IT# <br /> _- _ _ _--� � - �.�,. �--� - � <br /> Owner/Authorized Agent Signature Date (Revis d 5 20/ 016) <br />