|
PERMIT APPLICATIC
<br /> BUILDING / MECHANIC,4L/ PLUMBING /SIGN /SPRINKLER/ 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 ` 6 ;''���� Y�j�"=� PROPERTY TAX#: i�.�.` ' �% �� ��a. "`� � ��-�� s��'
<br /> LEGAL for new construction: Short Plat/subdivision l=�'-1'�-t'"�.'„W � 5�d-�r J° ''"Lot No f�..°- '-' (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> r"
<br /> OWNER NAME: �-y-f�,��-� �- , �--�d� TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReer � �' c�`'" '� ,, ; '''�v'�'
<br /> CITY ,.��'�:�-"x..i�(' .F�,'� STATE �.�..�.^ ZIP s`i'� i z�3---� �
<br /> OWNER PHONE: " - � '..` � - :�a- ` �. OWNER EMAIL: ,r: :.. �=,,.; �":�', =,_ .. ... .,.., � „�,...-�
<br /> CONTRACTOR NAME; ;�^'; -a:,,r. `� _ . i: `�y } , . :��=_.
<br /> �
<br /> CONTRACTOR ADDRESS: srReer ,'.''� l s �I �B� �
<br /> ,l - STATE r ;. . ZIP :. _V",.-'.._.� e�
<br /> CITY �. �a,; �
<br /> CONTRACTOR PHONE: `_� 1 , --�Y.: - �.d .1 ( ''4 CONTRACTOR EMAIL: a . ,.-:•� 'r: . .> ;. .:... . .,�.�_ ;a�,; .; ,--i�:,.s..,�': _ w.�.
<br /> ' ' r
<br /> CONTRACTOR LICENSE#(REQUIRED): �.. '.;:.._. �"�',;�`, 'S"'���7;•��°•� CITY OF EVERETT BUSINESS LICENSE#(REQUIRE ): " � I
<br /> /
<br /> PRIMARY CONTACT: ❑ OWNER ❑�'�ONTRACTOR ❑OTHER(Please Specify) ��
<br /> CONTACT NAME: ,.�a - CONTACT PHONE: �� � ._ ���i,� �j"-( -`�°-�
<br /> �A� �t� i. �", �v_.iL� �L'.L�,:�..\ :Q- `�. .. er..i-.S' i.�'r.� a.�,�.,+:�i ... i...
<br /> CONTACT EMAIL:d,� �._,'1�,.-,'�� �
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: ; �-�� `� '=r" ' ' " � Contract Price of Work:$ ;%� � "
<br /> Proposed Use of Building: ;��,{ , ,;,��.�'::.»� Heat Source: ❑Gas ❑Electric ❑Other a�-� ,�;%:;,..'
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK � ' j�
<br /> `+-- -,�� . _ .. - . ��t �� �� <_,_.t� % r'`�_ p-� ;
<br /> fv',�.q �a�"�';��� ._?� «-, ; �i , 4.,. ... � t ,_� .
<br /> �! i i.� � .'� �.. c,t� L: - _.� ,, ,
<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 /> #°{ Lisf of Fixtures #�f List of Fi�ctures #°f List of Fixtures #of Lisi of Fintures
<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 /> SPReLV1SLEFt/ SdJPPRESSIOfd SV�"�'EldL
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained he�ein is true and correct. Work done pursuant to this permit must comply with
<br /> current federal,state,and loca!law. The granting of a permif 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 1 am authorized by the owner of this p�operty to perform the work for which application is made,
<br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WNC.
<br /> City of Everett Official Use Only
<br /> F---_-�--�-'--'�� _.e...�, PERMIT# I L � D
<br /> , � e �., 1
<br /> �
<br /> Owner/Authorized Agen Signature Date (Revised 5/20/ 016) �
<br /> i'�
<br />
|