Laserfiche WebLink
PERMIT APPLICATIO" <br /> BUILDIN�VIECHANICAL / PLUMBING / SIGNII�RINKLER/ 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 or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:�i"�C f � L+ � I{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: �`t'�. ; ��„� „ I�- TENANT NAME(If Commercial): �' � l- ��t1�l� <br /> OWNER MAILING ADDRESS: srReeT ��J�C'� I�-'�- e �'-�- �' ✓ r,�"`� <br /> CITY �� V� �-� � STATE ��� ZIP ���<� ! <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; �-;�'� � � �� !�� �-, ;� . ( i i-• `j <br /> CONTRACTOR ADDRESS: srReeT L �1 � �l � ���-�' S C. � � � i ���'� �� <br /> CITY ` �1"� ���' fi �,��3/�� �} �/--C. �TATE ZIP <br /> CONTRACTOR PHONE: _� � � �"' � � ' ` CONTRACTOR EMAIL: �-�'�"< ( � t' -�, ' -�t'4 i�c�!,�(i F�� .S ��tl1�i� C ('1 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): i��--`'}� ���' <br /> PRIMARY CONTACT: ❑OWNER , CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ��,-�,`� � � �`�j�rt° S CONTACT PHONE: (.�� � �� �� S �.�� �[ ( j lL <br /> CONTACTEMAIL: �/:t� fC; �� (: �,r'�� � �,y%'c.,_��( ��r1=� { [�:i� � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 2- �"`�t <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �mmercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �.< < � f ( a �c c� � , � ��itCE-� �-� Cc c� / �L1 's��� ���� <br /> I t � � �-� �`��� j �, � � , � ��/1 <br /> , <br /> ' � l <br /> _ � � <br /> C E�%; i t . ��,• i �� �. � . � >; ���� S ���.e� ,�� �� ��: ��'<, � ;A' <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 Fixtures #�f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 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 /> 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 Official before being 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 comply with the State Contsactors Law 18.27 RCW and 296.200A WAC. <br /> � City of Everett Official Use Only <br /> �—����,_��� I PERMIT# <br /> � �.�1��-�'�"i���. �'--' ���o ��- ��.�-- <br /> OwnerlAutho�Fied Agent Si,gnature te (Revised 5/20/2016) <br /> , ' l � <br /> � <br />