Laserfiche WebLink
PERMIT APPLICATIO <br /> BUILDIA MECHANICAL I PLUMBING /SIGN RINKLEFt/ 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: 1014- 4 G�r2 =A� ( � � i PROPERTY TAX#: <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � `1� (` LrjG� --✓ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETZed 6C I..,,,' <br /> CnY "Y C"�LW/ STATE 444 ZIP s+�� <br /> OWNER PHONE: q-2— OWNER EMAIL:' <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET <br /> CnY STATE j� ZIP <br /> CONTRACTOR PHONE: "`3'S-/'5i"F `/ rC�ONTRACTOR EMAIL: dtG�L�ytLc,S M44'm <br /> CONTRACTOR LICENSE#(REQUIRED): d AIAT T Ys�-t " CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0610VIt <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 5- <br /> ZGa� (ivl �y(� CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION 7 <br /> Existing Use of Building: Contract Price of Work:$ <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-O-yFy WORK: <br /> —0441 J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: lew _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 j 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 $ '1 Sink(Service/Bar/Mop/etc.) Other: <br /> S i <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 I 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 O1ficio!befor e' 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 ate Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE IT# <br /> t -� l <br /> Owne-FIAMR73rized Agent Signature Date (Revised 9/2312016) <br /> F � <br />