Laserfiche WebLink
Ill <br /> 1111.1 <br /> PERMIT APPLICATION <br /> , -1 BUILDING / MECHANICAL! PLUMBING/SIGN /SPRINKLER / DEMOLITION <br /> r' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 ) FAX 425-257-8857 1(E)everetteps@everettwa.gov j ww+rr,eYerethva,goviperrTrits <br /> (Blue or Black Ink Only Please) PI t�JEC7'SITE INFORMATION <br /> PROJECT SITE ADDRESS: Pia � c Pod's. _c.l Y IPROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivleion <br /> Lot No.' (attach copy of long legal description) <br /> _ CONTACT INFORMATION <br /> . <br /> OWNER NAME: di u ori; (' <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (p 31 g oaQ _ f <br /> ciTy STATE ZIP <br /> LAJ gS203 <br /> OWNER PHONE: ,S 36,L5 4 r 7.�c"r !OWNER EMAIL: <br /> CONTRACTOR NAME: �.\t tr 'n C <br /> CONTRACTOR ADDRESS: P STREET i 4 16ro&c .uo <br /> ciyy &).e.(1.i,,V y <br /> STATE v,‘,) ` - ZIP Ct 7�20 I <br /> CONTRACTOR PHONE: 42_5 25.3q 0560CONTRACTOR EMAIL• ��, Le <br /> CONTRACTOR LICENSE#REQUI#?ED� — d�"�� tr►`r t,���((� .cowl <br /> ( ) -^�►�"0t `7[.a- t R+ _ CITY OF EVERETT BUSINESS LICENSE#(REQUIREDI: ri <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: (_ <br /> CONTACT PHONE: 1')«-2.6 255 5 <br /> De,)010 LL <br /> CONTACT EMAIL: ► asylke * ,CO <br /> BUILDINGPERMIT APPLICATION' ' <br /> Existing Use of Building: Contract Price of Work:$_11‘262... ..0___________ <br /> Proposed Use of Building: Heat Source: Aas DElectric ❑Other <br /> Building Type; AFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-i of _ <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Ropair DTA. OSign ❑Sprinkler ❑Demolitiion ❑Change of ElCommercil Useustrial <br /> DESCRIPTION OF WORK: <br /> lace oas c,c c 4ex (i... — <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION <br /> PLUMBING it'ERIVIITAPIsLICATiON <br /> Type of Project: New Addn Alteration .Repair <br /> *of _ Type of Project: New Addn `Alteration _Repair <br /> I1sf.af.FtxturQs ......._ #of #of <br /> Fixtures List otRztures__.. ___ __ ._._List-of Fixtures #of <br /> Fixtuios F�xtres -- LtstrofFrxturas <br /> NC—Air Handling Units peal Pum Fixtures <br /> Forced Air Systems p Toilet Backflow Preventer(Inside Bldg) <br /> y Unit Heater Bathtub <br /> Gas Piping Boiler Urinal <br /> I Water Heater Lavatory(Wash Basin) Drinkin+ Fountain <br /> Refrigeration Shower Floor Drain <br /> Gas FireplaceWood Stove <br /> Gas Range Kitchen Sink&Disposal Grease Trap <br /> Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: <br /> Range Hood Clothes Washer Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mop/etc,) Other: <br /> SPRINKLER i SUPPRESSION SYSTEM <br /> Chemical or Water I 1No,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 horn the <br /> Building Official before 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 Official Use Only <br /> PERMIT \ 1 1 <br /> �k�d A a /2,27. 17 i �I �� ( i % 1 <br /> Ow sr/Authorized Age Signature <br /> Date (Revised 412312016) <br />