Laserfiche WebLink
0 4111/ <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> iljr"T3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits . <br /> (blue or Black Ink Only Please) PROJECT SITE INFORMATION " <br /> PROJECT SITE ADDRESS: I 1 p) LAZA ts\* Pk V EI CuCrETC Wi PROPERTY TAX#:Co>s',-)3 L4 c17 O") <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • CONTACT INFORMATION . <br /> OWNER NAME: 12.d S S V.u-- W 1l ..SUt�J /TENANT NAME(If Commercial): <br /> OWNER M `AILING ADDRESS: STREET .kL C1 L7.l'IAA W� (-NV c <br /> CITY '�%1/`16-CC-C. STATE ►"'�' ZIP 9 ii 1 <br /> OWNER PHONE: t-I� - 7...-Si - ' 302- OWNER EMAIL: >�W 1 L-se.. ea e.-AN.)t, P (---,reA,a1` .c‘="1"-.1 <br /> CONTRACTOR NAME: E UrG Ai 57 -Tc�r �z4cET ImAT �_ „_ <br /> CONTRACTOR ADDRESS: STREET SI°L-C) �} PACA J AU I- • <br /> IN 1�+ <br /> CUeg-(5{ {TSTATE (.f A—�,l ZIP CtS2Ot <br /> CONTRACTOR PHONE: -2-5-2- 2-3/l� • CONTRACTOR EMAIL: les//.Q�PS,stri as Oji <br /> CONTRACTOR LICENSE#(REQUIRED): COG-1246S 02.2..0 i- CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): &3 oil c <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NA E: l /��f CONTACT PHONE: 4 2 gam'_252_->i/9 <br /> LC S/ /P ��/�/] //� l3�`� CONTACT EMAIL: )I/e 1 - 1 4 Kraa0M14 . <br /> • • � BU�ILDING PERMIT APPLICATION <br /> Existing Use of Building: reS)� .�/r"T/(X.� t Contract Price of Work: ((�I 006' <br /> Proposed Use of Building: -Slf roe_ Heat Source: AGas ❑Electric 00 er <br /> Building Type: gsFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCo • ercial ❑Industrial <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair OT.I. ❑Sign ❑Sprinkler pDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: \ <br /> rc i Ja cefurnace a_nd cz K. cOYld/I7O�-- <br /> CaCp as hal- A-al-e-r- <br /> ASSOCiATED BUILDING PERMIT#(if applicable): <br /> ' .MECHANICAL.PERMIT AP-LIGATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn ‘/Alteration _Repair Type of Project: _New Ackin„Oe4. eration _Repair <br /> • <br /> #of #of #of List of Fixtures List of Fixtures List of Fixtures #of List of Fixtures , <br /> Fixtures Fixtures Fixtures Fixtures <br /> / NC—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 /> of Water Heater Refrigeration Shower Floor Drain <br /> • <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal N 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 /> ' : .• PRIi KLER/SiUpPRESSION 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.l am the owner,or 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 /> r ( � /) RI I � . PE Y IT \.... 04::::tr 03q <br /> I <br /> O ner/Authorized Agent Signature Date (Revised 5/20/2016) <br />