Laserfiche WebLink
r PERMIT APPLICATIOO <br /> BUILDING/ MECHANICAL/ PLUMBING 1 SIGN I SPRINKLER I DEMOLITION <br /> 4e7T 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:'7(Q 0Q S `-E* ({� W'+ _3 PROPERTY TAX#:d_ OS3ac00300 <br /> LEGAL f::r new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 1 P CONTACT INFORMATION <br /> V <br /> OWNER NAME: r� J? t<6iZ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S"[� <br /> CITY STATE ZIP <br /> OWNER PHONE: aC)tl- 56t - OWNER EMAIL: i�),�r&4G <br /> CONTRACTOR NAME. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: Z OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> /vEMAIL- <br /> BUILDING <br /> A (,4`501.} �, [(��7 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5 FFR A-L:T4!Q+&D Contract Price of Work: 5 <br /> Proposed Use of Building: Heat Source: ❑Gastric ❑Other <br /> Building Type: (JSFR-Detached ,ZSFR-Attached ECIDu lex ❑Multi-Famil -#of Units: _ ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ja'Remodel ORe air ❑T.I. OSi n C.IS rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ��hD F111)JPJn6- NOi7f C �cy 1�9LL-s <br /> �Sc- s <br /> dFF . C otil.��?�- <br /> ASSOCIATED BUILDING PERMIT# if applicable): !. 1'4/ G CM <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 lKitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin 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.•t 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.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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ( City of Everett Official Use Only <br /> P ITlelx—� I t) \IO` — 6G� <br /> 0'%v6rfALItI,rbrized Agent S19-nature I Dat I t `( sed 912312016) �I` <br /> �O <br /> y'� (o l 0 -, 00 1� <br />