Laserfiche WebLink
0 PERMIT APPLICATIOP <br /> BUILD9NG I MECHANICAL/ PLUMBING /SIGN /SPRING LER I DEMOLFK)N <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: q S2- 1 fi e ct✓e- /7-Vc- I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot Na (attach copy of long legal description) <br /> CONTACT INFORMA T 11ON --- <br /> OWNER NAME: p Cf 14 c TENANT NAME(If Commercial): <br /> OWNER MAILING1 ADDRESS: STREET <br /> L^ Q VC +y CITY STATE W' ZIP 6 Z O <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: m ll - YU d/ f-ro✓^ 06f f VA <br /> CONTRACTOR ADDRESS: STREET <br /> .Q Crry STATE ZIP <br /> CONTRACTOR PHONE: Z61C — 1\4V— Zi CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): rj IJ R CITY OF EVERETT BUSINESS LICENSE#(REQU D) <br /> PRIMARY CONTACT: P OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 11 � <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: o '' Heat Source: ❑Gas ❑Electric Wther <br /> Building Type: FR-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: QP)GC C- N° - j/D0 \�/! + l�� 5 `'a t^ UO <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 lKitchen 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 /> Chemical or Water No.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �jCity of Everett Official Use Only <br /> CXR <br /> canth <br /> er/ orized Agent Signatu a Date (Revised 9/23/2016) y <br />