Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING / MECHANICAL/PLUMBING/SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov( www,everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: .12919 00PROPERTY TAX#: <br /> LEGAL for new construction: Short Plt(subddvtsion_ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: V UW TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY ...,]rrJ?F <br /> -•� STATE 7�p j,,,,/D <br /> OWNER PHONE: 2� _,��n" OWNER EMAIL: <br /> CONTRACTOR NAME: �- <br /> CONTRACTOR ADDRESS: STREET �� Q <br /> CITY IcSTATE W k zip Zlo! <br /> CONTRACTOR PHONE: Q CONTRACTOR EMAIL: ( IC. ! Ghiklea-V royyi <br /> CONTRACTOR LICENSE#(REQUIRED):CtnVlta rVkW6-71d ri CITY OF EVERETT BUSINESS LICENSE#(REQUIRED).- <br /> PRIMARY CONTACT: ❑OWNER { CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: : L ' Circe <br /> CONTACT EMAIL d ,i �lr( P. C 'l ttt 1r1 •�o M <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buildin Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas lectric []Other <br /> Building T pe: FR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: le ❑Commercial []Industrial <br /> Type of Project; ❑New ❑Addition ❑Remodel ❑Re air ❑T.l. []Sign ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 105+0 Cluc*S5 <br /> ASSOCIATED BUILDING PERMI <br /> T#(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 <br /> Fixtures Lis!of Fixtures #of List of Fixtures #o/ List of Fixtures #of Fixtures Fixtures Fixtures List of 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 ShowerFloor 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 /> Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT:I 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.!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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Onit <br /> 1 PERMIT /� 1 <br /> , 11 0 (�I <br /> Owne lAuthorized Agent-Signature Dale (Revised 9/2Y2071j) <br /> f � <br />