Laserfiche WebLink
� � <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING / StGN ! SPRINKLER I DEMOLITION <br /> GTY OF EVERETT PERMIT SERVICES <br /> 32Q0 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E}everetteps@everettwa.gov� www.everettwa.gov/permits <br /> ' B1ue or Black Ink Qn�y Pleasej PROJECT S1TE INFORMATION <br /> PROJECT SITE ADDRESS; �3�� ° �` ,�y��� j,C��,,t1�- �',�,,.�,��- �: - pROPERTY TAX#: Q �S�yQ�'� <br /> LEGAL for new cons'truclian: Short PlaUsubdivision Lot No..................... (attach r,opy of long legal descript�on) <br /> CONTACT iNFORMATtON <br /> OWNER NAME: TENANT NAME(If Cornms�cial�: <br /> �1N1+lER MAILING ADDRESS: srHeer <br /> CIiY 3TP.7E 7_IP <br /> OWNER PHONE: p - c3D� -S.S��S'G� OWNER EMAIL: <br /> CONTRACTOR NAME (�'D�'/�J � L�T�N,�" �Q�F�/N�a 1 lV�.. <br /> CONTRACTOR ADDRESS: sTReeT »�.zy �s� ,�,.�,� 6'�C, ,� �71,� <br /> C1TY (����LL ... STAfE �� 7.IF� 9��� . . <br /> �ONTRACTOR PHONE: ,��-- �S- / CONTRACTOR EMAIL: � �`p,rQ�y,�,t' ��Z�,}fJ"/�/G,CGY>7 <br /> CC?NTRACTOR LICENSE#(REC1t31RL-17j; CQ�/�/�/�"D'1,1,�/YJ GITY OF EVERETT BUSINESS LICENSE#{i2EClUIREOj; D,3 `�"'(�r <br /> PRIMARY CONTACT: ❑OWNER I�ONTRACTOR ❑OTHER(Please Specify) _� <br /> _�.� <br /> CONTACT NAME, ' CONTAC7 PHONE: �` yz6-_/�8S—D/// � <br /> �ARA GO�PN/6�I� OF�/C� mA�A�7FR CONTACT EMAIL:��A. �3/QNE/�TLY✓�Q7F/N(�,Gp/n <br /> BUILDING PERMiT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ �� g��• 00 <br /> Proposed Use of Building: Cv�� Heat Source: ❑Gas ❑Electric ❑Other <br /> .�. �__ <br /> Bt�ilcilr�c�Ty�E F�-D�t�che�d ❑SFR-Attached ❑Clupl�� ❑Multi-Family-#�of Units: ❑Commercial ❑Industrial <br /> Type of Pro�eet. ❑New ❑Addition ❑Remodel [��;p�ir ❑T.I, ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use �' -� <br /> DESCRIPTION OF WORK: <br /> �-��- C�"�U���e� � ��CQ c�%l ��'Y''`��'f'4�' . <br /> ASSOClATED BUILDING PERMIT�{iF�� iicabie :. <br /> MECHANICAL PERM�T APP�ICAT�ON PLUMBING PERM�T APPL�CATfON <br /> Type of Project: _New _ Addn Alteration _Repair Type oi Project: _New _Addn _Alteratlon Repair <br /> Fixtures List of Fixtures Fixtures Lis!of Pixtures #�f List of Fixtures �°f List of Fixtures <br /> Fixiures Fixtures <br /> AIC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg} <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavatory(Wash 8asin) Drinkin Fountain <br /> Wafer Heater Refri eration Shower F�oor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes Clryer Hoaku Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BarlMopletc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMEN7:!have reviewed this applrcation and confirm the rnfo�mation contained herein is true and correct. Work done pursuant to this permi�must comply with <br /> current lederal,state,and local law 7he granting of a permrt only aulhorizes approved work and no devrations there(rom.Deviations must(irst be authorized in writing from the <br /> 8uilding�7ficia!be%re being authoiized under any circumsiance.1 am the owner,or I am authorized by the owner of this property to perform the work for which appfication is made, <br /> and I comply with the Sfate Contractors Law 78 27 RCW and'196.200A WAC <br /> City o(Everetl Offrcial Use CJnl,y <br /> , �l'E.�ts�t.� '..7, � n?0� PERMI�I�li�r���� <br /> '� �K3rnrneriAuthorized Agent Signature �af� (RQvrs�e!�����f2Ca7�) <br />