Laserfiche WebLink
. . 44.77. le PERMIT APPLICATIONS <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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION I <br /> PROJECT SITE ADDRESS: '� r <br /> rel>�/ lAkrft-OoB"'e7 A 04% PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> • <br /> CONTRACTOR NAME: )V^� <br /> j •-a <br /> )( pi„,,, \)V <br /> CONTRACTOR ADDRESS: STREET J,5-3 2.„5--- '0,..i y q cq <br /> ciry LV� ��f�! STATE LA--; � ZIP �,1S0 <br /> �1 <br /> �� <br /> CONTRACTOR PHONE: i-'I L'S 3 22_ L)C( (,. CONTRACTOR EMAIL: l <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):D�D✓J ED <br /> PRIMARY CONTACT: VI OWNER 0 CONTRACTOR 0 OTHER(Please Specify)_ <br /> CONTACT NAME: CONTACT PHONE: _S ,,,_V,c_ <br /> )-----1\\�` )�\t ti 1 ) CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew DAddition Remodel ❑Repair ❑T.I. OSign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <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 ?C Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 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 /> /` <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT:I 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 deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance./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 WA C. <br /> City of Everett Official Use Only <br /> / 9 <br /> _2 ) 1 PERMIT#r / � L <br /> o .er/Authoriz.. Agent Signature Date (Revised 9/23/2016) <br />