Laserfiche WebLink
• PERMIT APPLICA10J <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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 0C� , sog^;r, , A;W -tAXrC4JVa PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No1S` (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> ' OWNER NAME: TENANT NAME/(If Commercial): <br /> OWNER MAILING ADDRESS: STREET NrX vs S-b <br /> CITY h4/ t7/ STATE ZIP <br /> OWNER PHONE: rZ� -' C� f OWNER EMAIL: <br /> CONTRACTOR NAME: r Q� �,lJn <br /> CONTRACTOR ADDRESS: STREET q/o <br /> CITY ue-eSTATE ZIP ;✓L�j� <br /> CONTRACTOR PHONE: x,00 CONTRACTOR EMAIL: c,1� [`�,6"7 <br /> CONTRACTOR LICENSE#(REQUIRED)': Z I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER '®CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( OLI <br /> . � j ir CONTACT EMAIL: �,, c .`', <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: l Contract Price of Work:$ <br /> Proposed Use of Building: /v '�c( eat Source: RGas []Electric ❑Other n <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: ❑ Industrial <br /> Type of Project: ❑New ❑Addition Xemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition MChange of Use <br /> DESCRIPTIO L ORK: R <br /> r�vN-6/7, M cePdOo,�d/ ,! exp <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 /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:/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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> Owner/Authorized Agent Signature F Dae (Revised 5/20/2016) <br /> I� <br />