Laserfiche WebLink
� PERMIT APPLICATION • <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 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:v� �(��`�� � PROPERTY TAX#: ���Cf���` "'�� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (;� %� C,�('' � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srFteer (.,iCP�� �C�` �� �' <br /> CITY '� STATE I/�� ZIP L 3 <br /> OWNER PHONE: �}�} � � OWNER EMAIL: <br /> CONTRACTOR NAME; � (��� ��1� <br /> CONTRACTOR ADDRESS: srnEEr Gf ��� �� St'�% U �� C <br /> cilv STATE ��' ziP �nM1�'��? <br /> CONTRACTOR PHONE: �� �- �sIS� CONTRACTOR EMAIL: iL� (� (;.J :�,.� . ,LZ <br /> CONTRACTOR LICENSE#(REQUIRED): ��t�(I� U�"�J CITY OF EVERETT BUSINESS LICENSE� REQUIRE : V <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �(� � ' a[.t� <br /> �V� V;����� CONTACT EMAIL: (y k�� �,� �� <br /> BUILDING PERMIT APPLICATIO <br /> Existing Use of Buildin : Contract Price o k:$ ��� `� <br /> Proposed Use of Building: Heat Source: as ❑Electric ..�Other <br /> Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family-#of _._�--���Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> �1��ICi�,�� /�1�-b C'���� �t�- �8( ��1a� _ <br /> � V <br /> ASSOCIATED BUILDING PERMIT# if ap licable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration �Repair Type of Project: New Addn _Alteratio� _Repair <br /> #of List of Fixtures #of List of Fixtures #�f List of Flxtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fi�rtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <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 Grease Trap <br /> Gas Range Ductin 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 /> 3PRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this applrcation 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 fi�st be authonzed in writing f�om 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 com ly with t State Cont tors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Officral Use Only <br /> P RMIT# <br /> � 1� a� �r��- � — <br /> O r/Authoriz Agent ignature Date (Revised 9/23/2016) <br />