Laserfiche WebLink
PERMIT APPLICATIO <br /> BUILDINC�IECHANICAL/ PLUMBING / SIGN RINKLER/ 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@everetiwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PIvOJECT SITE ADDRESS: i L>f L; R5�11GE�? .11:�C PROPERTY TAX#: 1.�.;�z,�>"ylG+(3v��v <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �~d�-'L� " 1�� +-+,� F'"�2�c':�b� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr Zcs�v 8Al�Ek' �-�� <br /> ciTv ��1 E�.�rt— STATE L`��' ziP Ci�3'7.1s i <br /> OWNER PHONE: ��ZS z� � `f�r<%�% OWNER EMAIL: CA�t-c3,Ea p�o�-� L9"^`�,�.`�'� <br /> CONTRACTOR NAME: ��i}-�i ��. �a2,n�.CS l,�;G <br /> CONTRACTOR ADDRESS: srReeT Z�U 1{- CCs�-�s ,4v,� U�..r � <br /> CITY �\/�,p_�7� STATE (,W�,i� ZIP �ZQ � <br /> CONTRACTOR PHONE: �-f-GS .�13�3 �}-?5Z CONTRACTOR EMAIL: '�'LJ+���"'"'���t�' Sr*�.�°�,r�.��s .cc,�s <br /> CONTRACTOR LICENSE#(REQUIRED):�,4.�:.�F{.,y► Ls,�> ',�N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �-pJ �,��,,� CONTACT PHONE; �-z.���t$ �j.��2 <br /> CONTACT EMAIL: ��,:(_�dsr�,r� �,�'•ar_e�r�d.e.�a�.y-c�_c:�,ti <br /> BUILDING pERMIT APPLICATION <br /> Existing Use of Building: i�� Contract Price of Work:$ j��L-�t3 � <br /> Proposed Use of Building: �- ���c�� Heat Source: ❑Gas ❑Electric ❑Other /��^�°� <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑industrial <br /> T pe of Pro�ect: New ddition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: �'G�t,��._.�j,Q� ��1 �S� �� �� ,`�� ����� <br /> ASSOCIATED BUILDING PERMIT#(if applicable : `��� >> Z�s ���' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APP�ICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration Repair <br /> #of List of Fiztures #of List of Fiatures #of ��st of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavatory(Wash Basin) Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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 devrations fherefrom_Deviations must first be authorized in writing from the <br /> Building Official6efore 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> / `- .f ���� ��L�//� PERMIT# � I �!^(,��' � C-1� � <br /> � 1 (./ <br /> OwneNAuthorized Agent Signature Date (Revised 5/20/2016) , � Z <br />