Laserfiche WebLink
PERMIT APPLIC <br /> BUILDING / MECHANICAL/ PLUMBING /SIG 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: 100 i 10. J1, PUci J PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: V Q f C' o w w V �, (JIC-�C TENANT NAME(If Commercial): P p i n C,lnt.C� <br /> OWNER MAILING ADDRESS: STREET 2-06(-) TU�^-L 7 S fi p y!� <br /> CITYff -� tf e t e I' STATE lI�/ I ZIP 2 C) <br /> OWNER PHONE: '42-T'' j d(S ^ 1 C)G 1OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CIN (% f STATE ZIP 1 2C3 <br /> CONTRACTOR PHONE: Z r t./) V- 9 3 S6 /� CONTRACTOR EMAIL: 1-I j C G1+S r ' •-J C u— ? <br /> CONTRACTOR LICENSE#(REQUIRED): (p�JZ (e l' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S 3 uI I <br /> PRIMARY CONTACT: ❑ OWNER RCONTRACTOR ❑OTHER(Please Specify) <br /> COACT NAME: CONTACT PHONE: <br /> ` 1 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 150':K• 4S <br /> Proposed Use of Building: Heat Source: ❑Gas []Electric ❑Other <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: <br /> ie ,ij d oc.;!' <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.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 /> 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 /> Z G/b PERMIT# ^ 00(o <br /> w r/Autho I ed n Ignature Date (Revised 5/20/2016) <br />