Laserfiche WebLink
PERMIT APPLICATION11h <br /> OL BUILDINW"ECHANICAL / PLUMBING / SIGN / SP INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 i(E)everetteps@evereft.wa,gov j awrw everethva gcvloermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: al 11 -0 PROPERTY TAX M <br /> 9 <br /> ,LEGAL for new construction: Short Plat-ub iiviS:"7; <br /> —_ L'rt No^ ......._ (attach ropy:)t long'.egat desc,nption) <br /> CONTACT INFORMATION <br /> OWNER NAME: aA , TENANT NAME(If Commercial). <br /> OWNER MAILING ADDRESS: <br /> OWNER PHONE: $ C1o�1v.l� OWNER EMAIL: <br /> CONTRACTOR NAME: ; <br /> CONTRACTOR ADDRESS: STREET <br /> ciry SLATE vt4k ZIP <br /> CONTRACTOR PHONE: -I +(`7, w CONTRACTOR EMAIL: °�y <br /> CONTRACTOR LICENSE#(REQUIRED): �� "' k 7�7�.�.r /" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED}: I�l(' <br /> PRIMARYwz— <br /> CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: <br /> k �J CONTACT PHONE; <br /> l CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ cqoC> <br /> 3roposad Use of Building: Heat Source: as lectric ❑Other <br /> iaiilding Tyae FR-Detached ❑SFR-Attached ❑Du lex []Multi-Famtly-#of Units ❑Commercial ❑Industrial <br /> F ype of?roject: ❑New Addition ❑Remodel ❑Repair ❑T.I ❑Sin ❑Sprinkler ❑Demolition []Change of Use <br /> )ESCRIPTION OF WORK: <br /> 1ps+d-uG-�- ftns -T'Ek-"� kJ2q* PUA.'qp <br /> tSSOCIATED BUILDING PERMIT# `if a plicablep <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: —New _ Addn _Alteration —Repair Type of Project: New Addn Alteration <br /> MCIothes <br /> — — -- —Repair <br /> st of Fixtures #°f Me, <br /> #of <br /> Fixtures List of FixturesList of Fixtures List of Fixtures <br /> FixturesFixtures <br /> ir Handling Units t Heat Pump Backflow Preventer(Inside Bldg) <br /> Air Systems Unit Heaterb <br /> ing Boiler Urinal <br /> eater (Wash Basin) Drinking Fountain <br /> Refrigerationr Floor Drain <br /> place Woad Stoven Sink&Dis osal Grease Trap <br /> nge Ducting asher <br /> Dryer Hookups Other: Roof Drains <br /> Range Hood s Washer Medical Gas <br /> Exhaust Fan Heater Other: <br /> Sink(Service/Bar/Mop/etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> :KNOWLEDGEMENT: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 /> irront federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations most first be authorized in writing from the <br /> ulding Official before being authorized under any circumstance.t am the owner.or I am authorized by the owner of this property to perform the work for which application is rnade, <br /> A I comply will-,the State Contractors t.aw 18.27 PCW and 256.2GOA WAC. <br /> City of Evereft Official Use Only <br /> PER <br /> ,1 A- <br /> 3 t� - <br /> rrnerlAuthorized Agent Signature Date <br /> (Reviser!91231'2016) <br />