Laserfiche WebLink
PERMIT APPLICATION <br /> 4,67T BUILDING/ MECHANICAL/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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �( �'v �� L�I PROPERTY TAX#: `� a 2- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (cn t 'i (')y/�TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t �fq <br /> CITY Cts if V ..--- STATE WA ZIP <br /> OWNER PHONE: 3�r�)- ( - 4�5`2 r OWNER EMAIL: <br /> CONTRACTOR NAME: " r <br /> CONTRACTOR ADDRESS: STREET t �o-7 <br /> CITY { rlI STATE <br /> CONTRACTOR PHONE: Z� , - CONTRACTOR EMAIL: la I� <br /> CONTRACTOR LICENSE#(REQUIRED): �,n , <br /> CITY OF EVERETi BUSINESS LICENSE#(REQUIRED): (j , <br /> PRIMARY CONTACT: D OWNER ONTRACTOR D OTHER(Please Specify) i <br /> CONTACT <br /> �?���E. n „�� CONTACT PHONE: ��.�.�-�� -,���-J <br /> ((�� CONTACT EMAIL: � GL �(f�f'I� �J7— <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: tGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached []Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: UNew ddition ❑Remodel DRepair UT.I. USign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> J)nlto"" <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: Now _Addn _Alteration _Repair <br /> #of -40T #of <br /> Fixtures List of Fixtures List of Fixtures #of <br /> Fixtures Fixtures Fixtures List of Fixtures List of Fixtures <br /> A/C-Air Handling Units Neat 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 Ran e p <br /> g Ducting dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater <br /> Other: <br /> Exhaust Fart Sink(Service/Bar/Mopletc.) Other: <br /> SPRIN L.ER/SUPPRESSION SYSTEM <br /> Chem(cal or WaterNo,of He EEEEI I <br /> ACKNOWLEDGEMENT.•I have re iawed 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.l 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply`wit the State Contractors Law 18.27,W6W and 296.200A WAC. <br /> ! ( City of Everett Official Use Only <br /> PERMIT <br /> Owner/Auto razed 'Signature Date (Revised 9/23/2016) <br />