Laserfiche WebLink
PERMIT APPLICATION <br /> 4e7T BUILDING / :;HANICAL/ PLUMBING / SIGN / SF:aii KLER / 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@everettwa.gov I www everettwa,gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX M <br /> LEGAL for new construction: Short Plat/subdivision LafiNa._ _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: o KZA-*OVA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETLc C - <br /> CITY STATE ZIP <br /> OWNER PHONE: f~p , OWNER EMAIL: <br /> CONTRACTOR NAME: C11�'YA <br /> CONTRACTOR ADDRESS: STREET tL '�" r / <br /> CITY t yy <br /> _l µ' _ STATE v' ZIP tA <br /> CONTRACTOR PHONE: -i r~ L{ - CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): i .('}1 t, ) }. '.i , L .� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ('z,6 i <br /> PRIMARY CONTACT: ❑OWNER CltONTRACTIOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: <br /> 1 CONTACT PHONE; <br /> CONTACT EMAIL: P '4f, C'1�Y1�u�d-► r 1" [�M <br /> BUILDING PERMIT APPLICATION <br /> 1Existin2 Use of Buildin Contract Price of Work;$ <br /> Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> ape of Proect: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Chane of Use <br /> DESCRIPTION OF WORK; <br /> Rep Llv&� &,k5 <br /> ASSOCIATED BUILDING PERMIT#`it applicable <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration TRepair Type of Project: New _Addn _Alteration _Repair <br /> #of 7 List of Fixtures #of #of <br /> List of Fixtures List of Fixtures <br /> #of <br /> Fixtures 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 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/Mopietc. Other: <br /> SPRINKLER /SUPPRESSION SYSTEM <br /> Number of Heads <br /> iCKNOWLEDGEMENT 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 /> urrent 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 /> tuilding 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 /> no I comply with the State Contractors Law 18.27 RCW and 296.200A WAC, <br /> City of 110 ial Use Only <br /> T � ; <br /> PERMIT# <br /> rwn riAuthorized Agent Signature bate (Revised 912312016) <br />