Laserfiche WebLink
• <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EvERETT PERMIT SERVICES <br /> 4wrr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everettepsigevenattwa.gov I www.everet+,Ma.gov/perrn <br /> mk Ink OnIX "tease} <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:/-Z&A 3 .2D�`'bk. 6r- 1PQn000*r'V TA <br /> LEGS for new construction: Short PlatisubdivisioP-- ct No. (attach copy of lorg legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: bAAi­o &A-AZIj TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: S—REEEET 1.26.2 R 'go 4 fa- 5E <br /> OWNER PHONE: C t7 STA7E 1,J A <br /> it 982og <br /> OWNER EMAIL: <br /> CONTRACTOR NAME t Ci16072AJIC'A�' <br /> ,CONTRACTOR ADDRESS: <br /> C7y STATE A <br /> ZSG <br /> CONTRACTOR PHONE: YZ6 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUflqED):AM SEd 71P q- I <br /> BUSINESS LJCIENSE#(REQU1114D) e), !oj2�Z- <br /> PRIMARY CONTACT, 0 OWNER 21CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE; <br /> N CONTACT EMAIL: 64Z <br /> SUILD]ING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: 13Gas OEIactric Cother <br /> BuildinqType: MSFR-Detached OSFR-Attached ODuplex C3N?IWfi-Famj1y-#of Units: Uoommerciai 101ndus�trial <br /> Type ofProjeot: ElNew OAddition ❑Remodel ORepair C3T.1, USign OSprinkler 130emolitior, 13Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUtLDING PERMIT# if 2alicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn —Alteration--_Repair Type at Project _New —A;dn �Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> AIC-Air Hand[ing Units Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> For reo Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipiri Boller Lavatory(Wash Basin) Drinking <br /> iVVater, ter Refrigeration— Shower I Pfoo Fountain <br /> Gas Fireplace Wood Stove r Drain <br /> Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting <br /> Dishwasher Roof Drains <br /> Clothes�Der_Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other; <br /> Exhaust Fan Sink(Servicelaarliviop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> IN umber of Heads <br /> ACKNOWLEDGEMEIVT 1 have.re iewed this application and coirwm the information contained harair is'rue and correct. Werk done pursuant to this permit must comply wjtrn <br /> current federai,state,ac,Ioaa?law. The granting of a permit oriy authorizes approved work and no deviations thereft-m.Dawations must first be authorized in w&.`ng ftnn the <br /> Sui,laing Officiat before being avthor€zed under any circumstance,lair the owner,or i am authorized by the owner of this property to perform the work for wtich aoicatfDn is made, <br /> and I cOmpdy with the State Contractors Law 1817 RCW and 296200A WAC, <br /> city of Evaran offic"'a;Use orry <br /> PERWT# <br /> Owner/Authorized Agent Signature Date (Revised&'20,1201$) <br />