Laserfiche WebLink
� • <br /> PERMtT APPLICATION <br /> BUILDING / MECHANICAL 1 PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY dF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (R}425-257-8810 ( FAX 425-257-8657 ((E}evareflr�ps'"��,''ra�veretRwa,go+r� www.everettwa.gov/permits <br /> (B1oe or Black Ink (3n[y Ple�sej PROJECT Si?� Mt��tJ�ltNfA'T1�DN <br /> PFtQJEGT SITE ADDRESS: 5 G.�"�' ���� i y" PROPERTY TAX#: <br /> LEGAL for new constructlon: Short PlaUsubdivlslon Lot No,_ (attach copy of long legal descriptlon) <br /> GONT'ACT INFCiRMA71t9N <br /> OWNER NAME: ' <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT <br /> cro srare � � � ziP a �� <br /> dWNER PHONE: z z�pS �� ,� OWNER EMAIL: <br /> CONTRACTOR NAME; !-��"'(���-- <br /> CONTRACTORADDRE55: STREET �`.^�� (x <br /> �� STATE �� ZIP �2Q' <br /> CONi'RACTOR PHONE: "r',,} � CONTRACTOR EMA{L: ��%�'„�,�I�. � G�1'�l�'e'Gt»'�'1�� • CQVYt <br /> CONTRACT�R LICENSE#(REC�uIR�O�:(,',j�Y1�'PCl YY�,�I U�ZG�!'� CfTY OF EVERETT BUSINESS LICENSE#{REC1UiRE[}): �tyC�(� <br /> PRIMARY CONTACT: ❑OWNER 1,�i CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: • CONTACT PHONE; � �'�C� �� <br /> ���� CONTACT EMAtL: (���� E. C��E'�� �P0 M <br /> BUILDINt3 PERlVI11`A�"�'LICATIC11� <br /> Existiia Use of Bulidin�: Contract Prlce of Work:$ � .�� <br /> Praposed Use of Bufidin : Heat 5ource: Gas C7Electric ❑Other <br /> Building T ps; SFR-C}etached ❑SFR-Attached �du�iax Oblulki-Famiiy-#�f Units: OCommercial ❑Industrial <br /> T pe of Prajar,t: ❑New ❑Addition ❑Remodel �Rt�pa(r ❑T,I. ❑Si � ❑Sprinkler ❑Demolition ❑Changr�of Use <br /> dESGRIPTION OF WORK:1��I ��� �.__ _ ������ � ��C j,.,- LI �� �rKQC�i�,��, <br /> ' �l�t51� �.�9" b1r J'I�I. <br /> 1.:_ �� <br /> CGi�� <br /> A550CIATED BUILDING PERMIT# fC applir..able ; <br /> MEGHANICAL pERMIT APPLIGATION PL�E149BINC� F'�RMIT ApPLCGATIC)N <br /> Type of Project: _New Addn _Alterotlon _Repalr Typa of ProJect: New _Addn Alteratlon _Repalr <br /> ��� Llsf of Flxtures #of <br /> Flxtures Fixtures Llst o/Flxtures Flxfur s L/sf ol F/xfures Flxtures «st ol Fixtuies <br /> AIC—Air Handlir� Units Heat Pump Toilet Backflow Preventer lnside Bldg) <br /> FUrced A!r S siems Unit Heater Bathtub Urinal <br /> Gas�'ipin Boiler Lavato (Wash Basin� Drinking Fountain <br /> Water Heater Refrigeratlon Shower Floor Dra1n <br /> Gas Fireplac� Wood Stove Kitchen Sink&Dis osal Grease Tra <br /> Gas Ran e Ductln Dishwasher Roof Drains <br /> Clothes dryer H�q�ku�s Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heafer Other. <br /> Exhaust Fan Sink(Service/Bar/Mo /etc. Other: <br /> SPRtNKL.�R 1 SUPPFt�SStON �Y�TEM <br /> Chemical or Water No, of Heads <br /> ACKNO WLEDGEMENT:/have revfewed thls applicatlon and conl/rm the(n/ormaUon contained herein is We and correcL Work done pu�suant ro thls permif must comp/y with <br /> current/eder�f;stafe,�+nd loca!1»w. The grsnting of a ryermH only authorfzes epproved work and no devla((ons lherefrom.Devleflons musf flrsf be authorized/n w�lling Irom the <br /> 6edlding qffJclal tre(orv hwliry+auflsorrreci lindr�r any clrcca�stnnce.I am the owner,or 1 am aufhorized by the owner of this property to perform the work!or whlch applicallon is made, <br /> and!comp(y wifh the Sfate Con/raclors taw 18.27 RCW and 296.200A WAC. <br /> Crty o1 Everett ONlcral Use t}ndy� <br /> 1 M1 � . I�'�� PERMIT ��`�l � <br /> 1 <br /> `Owne lAutharized Agon }�nalura Date (Rr�viseri 9l2��PQl:Gj <br />