Laserfiche WebLink
_._... ----.— __ <br /> — - <br /> • • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRlNKLER!DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32�0 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue ar Biack Ink Only Pfease) PRO.�ECT SITE INFQRMATfON <br /> PRWECT SITE ADDRESS: � '�J�,i� �"�� �� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description} <br /> CONTACT INFORMATION <br /> OWNER NAME: �°, f�/ � , c ���� �.. TENANT NAME(if Commercial): <br /> OWNER MAILING ADDI2ES�: sTREET ��� '�' �'� �' `;� �., <br /> ¢ <br /> rl7y `�--�.�� STATE � 21P ��`j�,9� <br /> OWNER PHONE: . �� ' ���� OWNER EMAfL: z <br /> CONTRACTOR NAME: �` ��,��3 ���i�� C G�,.� ��` 1v � �`d"� �-�� <br /> CONTRACTOR ADDRESS: srReer F��'�,��.� ��� � y �,r <br /> CIN f �%�.1' . � � STATE J ?� ZIP '�'" ����j �/� <br /> CON7RACTOR PHONE: �� CO TRACTOR EMAIL: ,�`� C.i�� �+C��.� '2 ����}"�'° <br /> CONTRACTOR LICENSE#(REQUIRED): ���.������`""�� CITY OF EVERETT BUSINESS LiCENSE#(REQUIREDj:t,,�—v�-�Cf� <br /> PRIMARY CONTACT: 0 OWNER ! NTRACTOR ❑OTHER(Please Specifyj <br /> CONTACT NAME: CONTACT PHONE: �--�.'��— =��y � ��..C� <br /> � '� ��.��...� CONTACT EMAIL:�t�,? ������ ��'� `�C� t,�� �". �'�� � � �� ��� <br /> BUILDIMG'PERMIfiAPPLICATION <br /> Existin Use of Building: Gontract Price of Work:$ � ���-"" <br /> Proposed Use oi Building: Heat Source: ❑Gas ectric �Other <br /> 8uildin Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famify-#of Units: ❑Commercial ❑Industriai <br /> Type of Pro ect: ❑New ❑Addition ❑Remodei epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��,Y jl��,�� Y{��J����j��� <br /> �` ��� I vi JL-��n � ` <br /> ASSOCIATED BUILDING PERMIT#(if a plicable): <br /> MECHANICAL PERMIT APPLIGATION PLUMBING PERMJT APPLICATION <br /> Type of Project: New Addn Alteration Rspair Typa of Project: New _Addn Alteration Repair <br /> #of List of Flxtures #of List of Fixtures #�f List of Fixtures #of Llst of Flxtures <br /> Fixtures Fixtures Fixtures Flxfures <br /> A/C—Air Handlin Units Fleat Pump Toilet Backflow Preven#er(inside Bidg) <br /> Forced Air Systems Unit Fieater Bathtub Urinal <br /> Gas Piping Boifer Lavato Wash Basin) Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Woad Stove Kitchen Sink&Dis osal Grease TTap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: C{athes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink{Service/Bar/Moplefc.) Other: <br /> SPRINKLER/SUPPRESSiON SYSTEM <br /> Chemica�or Water No.of Heads <br /> ACKNOWLEDGEMENT.1 have reviewed this apptication and confrrm the information contained herein rs true and correct.Work done pursuanf to this perrnit musl comply with <br /> currenf federal,state,artd Ioca/law.The granting of a permd only autfrorrres approved vroric and no devrations therefrom.Deviadons must first be authorized in wri[ing from the <br /> i Building Official befoie being authorized under any circumstance.1 am the owner,or/am authomed by the owner of this property to pedorm the work for which applicatron is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> i ��,� � Ciry of Everett O�cia!Use Onty <br /> � PERMIT# <br /> �� � ��� � ����� � �� � � � <br /> i OwnerlAuthorized Agent Sign re Date (Revised 9/23/2016) <br /> I <br /> i <br />