Laserfiche WebLink
I'tKMI i APPLICATION <br /> BUILDIN^ ' MECHANICAL / PLUMBING / SIGP PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIUL- <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everettepscaeveretivva yriu I www.everektwa.gov/permits <br /> (Blue or Black Ink Orly Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision — — i ut No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> JWNER NAME: f I ' TENANT NAME(If Commercial): ------- <br /> JWNER MAILING ADDRESS: STREET <br /> CITY <br /> *� STATE <br /> ZIF' - <br /> )WNER PHONE: < t✓ dOWNER EMAIL: <br /> 'ONTRACTOR NAME; " <br /> Tf <br /> ,ONTRACTOR ADDRESS: STREET <br /> CITY „ ..•...*. .., <br /> ,. STATE �,:` •` "}_. ZIP � �y ms `s l <br /> 'ONTRACTOR PHONE: ` r { <br /> CONTRACTOR EMAIL: ) ' ..��:��: ..,-I" 1�(;t; € VZd. I-� `t2 <br /> :ONTRACTOR LICENSE#(REQUIRED); { - 1'" OY4 7t ') CITY OF EVERETT BUSINESS LICENSE#(REQUJRED):� �kt( <br /> `PIMARY CONTACT: ❑OWNER `,'C ONTRACTOR ❑ OTHER(Please Specify) <br /> •ONTACT NAME- <br /> A CONTACT PHONE: Lt A KOSS: , <br /> CONTACT EMAIL: t'"}.( } <br /> BUILDING PERMIT APPLICATION <br /> xisting Use ofilliltirt' Contract Price of Work: ' <br /> rgpos+rd Uses of Building: <br /> Heat S ,urue: DCyas t Elr;ctri(. ❑t7ther <br /> ullding Type , R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -il of Units: <br /> Y ❑Commercial ❑Industrial <br /> rrae of Projed: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ©aign ❑Sprinkler ❑Demolition ❑Change of Use <br /> ESCRIPTION OF WORK: <br /> 3SOCIATED BUILDING PERMIT#(if a _licai�ie}; <br /> MECHANICAL„ PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> pe of Project: _New — Addn _Alteration _Repair Type of Project: —New Addn Alteration Repair <br /> #of #of #of — _Repair <br /> List of Fixtures List of Fixtures List of Fixtures '#of <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(inside ffldg) <br /> Forced Air Systems Unit Heater Bathtula <br /> Gas Piping Urinal <br /> P 9 Boiler Latra,or (Wash ga in Drinking Fountain <br /> Water Heater Refr eeration Shower <br /> Gas Fireplace Wood Stove Floor brain <br /> Kitehen Sink Disposal Grease Trap <br /> Gas Range Ducting Dishwasher <br /> Clothes D er Hookups Other: Roof Drains <br /> Clothes Washer Medical Gas <br /> Ran e Hood V7Vater Heater <br /> Exhaust Fan Other: <br /> Sink(Service-;BariMop/etc.) CJtt�er <br /> SPRINKLER /SUPPRESSION SYSTEM <br /> Nur er of Heads <br /> -(NOWLEDGEMENT: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 /> ent 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 <br /> ding 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 wh,;ch application ithe <br /> s made. <br /> 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Qnly <br /> PERMIT <br /> nerlAuthartaatd Agent Signatcrre Llat ('Rewsed 9121125 7) <br />