Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER / DEMOLITION <br /> VIPS,a .7- 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,gaav I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> a <br /> PROJECT SITE ADDRESS: 51*0 S 2Cg e, PROPERTY TAX#: <br /> LEGAL for new construction: Short Ptatfsubdlvislon Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION :, <br /> OWNER NAME: hrh'S KU/136141w TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE 7IP <br /> OWNER PHONE: 2O(t, ii/3 9500 OWNER EMAIL: <br /> e <br /> { <br /> CONTRACTOR NAME: H. yy s 1 riG-- <br /> CONTRACTOR ADDRESS: STREET 146 BY-bctd LiXt <br /> }A1 (�,�^"7 { <br /> _.. CRY I / STATE <br /> �W -. ';t' e V 2—C) _... <br /> CONTRACTOR PHONE: 9 o5 CONTRACTOR EMAIL: d ao e t G 'lY1-eatiel :C iyy <br /> CONTRACTOR LiCENSE#(REQUIRED <br /> ) T t <br /> u Y i�111,1,1 -7-2.41n a CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):/ LpCelq <br /> PRIMARY CONTACT: ❑ OWNER 46 CONTRACTOR ❑ OTHER(Please Specify) t <br /> CONTACT NAME: CONTACT PHONE: Has ass,bT <br /> CONTACT EMAIL: dela tii,e Dcm„,t,vecofiriq .4,)rn <br /> BUILDING PERMIT APPLICATION ,-- <br /> Existing Use of Building: Contract Price of Work: $ ' 72.77.5 I <br /> Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br /> Building Type' NSER-Dotanched El SFR-Attached ODuplex ❑Multi-Fancily-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> R12,1910.6e/ ya,4) 64AA4tetze, c=i- 147 0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable), <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn V lteratIon Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> j 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 Kitchen Sink&Disposal Grease Trap <br /> Gas Range g Ducting DishwasherRoof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer -Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> --Th <br /> 5 51$ .J7 �oS - OL . <br /> 'Owner/Authorized Agen lgnature Date (Revised 9/23/26016) <br />