Laserfiche WebLink
0 PERMIT APPLICATION 0 <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 I(E)everetteps c@everettwa.gov I www.everettwa.gov/permits <br /> Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> L 2ecu54o• .Z-00�DO <br /> PROJECT SITE ADDRESS: -7 - /1 l= I� X d L V (A- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No. (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: % - ren Vf �aCQ <br /> TENANT NAME(If Commercial): 7 Ci u <br /> OWNER MAILING ADDRESS:V STREET poll -� %JP✓ ;� Yl t� <br /> ({�.� C pZx"� <br /> �Y�� Z. STATE ZIP <br /> CITY <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: S' - ' LLL <br /> CONTRACTOR ADDRESS: STREET f <br /> CITY l 'ii-et' �.yv STATE ZIP <br /> CONTRACTOR PHONE: C CONTRACTOR EMAIL: (��1� i C '►�U L-L7YtS <br /> CONTRACTOR LICENSE#(REQUIRED): z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: O OWNER Jq CONTRACTOR OTHER(Please Specify) °��r�` It <br /> ( �C�i`( <br /> ONTACT PHONE: <br /> CONTACT NAME: C <br /> t CONTACT EMAIL: 1 Co-_Q_ Va r Cl f L <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buildin : Contract Price of Work:$ <br /> —77:Pro osed Use of Building:_ Heat Source: OGas ❑Electric ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Family#of Units: <br /> Commercial O 1 ndustrial <br /> Type of Project: ❑New OAddition ❑Remodel ❑Repair OT.I. []Sign OSprinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: i j15T{ t � U'� a� � S I � )�l S1n4-1Er-r (.t <br /> ASSOCIATED BUILDING PERMIT# if a livable <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration ,Repair Type of Project: ___New _Addn _Alteration _Repair <br /> #of #of #of List of Fixtures <br /> #ofjA/C <br /> List ofiFWures List of Fixtures List of Fixtures Fixtures <br /> Fixtures Fixtures Fixtures <br /> Toilet Backflow Preventer(Inside Bld <br /> -Air Hin Units Heat Pump Bathtub Urinal <br /> ed Air ems Unit Heater <br /> pip'in Boiler <br /> Lavato ((Wash Basin) DrinkingFountain <br /> Water Heater <br /> Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Dustin Dishwasher Roof Drains <br /> Gas Ran a Medical Gas <br /> Clothes D er Hookups Other: Clothes Washer <br /> Water Heater Other: <br /> Range Hood <br /> Exhaust Fan Sink Service/Bar/Mo /etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or water No.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 focal 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 1 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 ROW and 296.200A WAC. City of Everett Official Use Only <br /> PERMIT# <br /> Own)rkoft A Sign u e Date (Revised 9/2312016) <br />