|
4:77 PERMIT APPLICATION
<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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: \ 0 2.c) ), ( u_'Tr 1. PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: C__:,`,\4,c 1c,1c-` Sc,F'e S p,,;;,,s L TENANT NAME(If Commercial): 11\v \!,\ri.c _cok. SA,,,,,", )(-
<br /> OWNER MAILING ADDRESS: STREET l e)2.c,t ) l:t l'\ /!..f.-- S L,---
<br /> CITY
<br /> rCITY h kiL,-i_j-fr STATE (,-• I\- ZIP f 2i )
<br /> OWNER PHONE: OWNER EMAIL: //
<br /> CONTRACTOR NAME: /,Aot-\SCA 7,vt„�\_,VA) ' LLL
<br /> CONTRACTOR ADDRESS: STREET IC,v&i l\ Cir,!,e, `Z d\ WL
<br /> CITY ('\iJ`,v-t/ STATE 1..J P ZIP Cj ic 2 j Z
<br /> CONTRACTOR PHONE: C2_00 IS ( 7- 16� CONTRACTOR EMAIL: icr.tScv\ ; N'b \Jc-r, u''- ( � iw,G, 0- , ,-:_t...._...____
<br /> CONTRACTOR LICENSE#(REQUIRED):1"0hC_14 fl ;S"]'(p 1.C.C 'OF EVERETT BUSINESS LICENSE#(REQUIR ) Q1`
<br /> PRIMARY CONTACT: 12/OWNER ❑CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (G L 1,) S 7 g 1 k -Z 5
<br /> C. lc., ,:,,SG 1 CONTACT EMAIL: Q, \A Grl o
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ PJk C )
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other _
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ciCommercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition DRemodel DRepair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: r' / ��, §
<br /> __w,g�CV Cl 'C` ��:� (c''6,,.'.- ` JC%\q�X tr i%;,.+'� C ':•Al':a\ o f - .- .e, IXD� . 11
<br /> L'1���5 C:`ilc..r, ,
<br /> ',\ etvM a,,,-, tF<:w.,,,,;,\ ,.
<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 #of #of #of
<br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher ',Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas ,_c---
<br /> Range Hood Water Heater Other: 0 •0.11 01
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<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 WAC.
<br /> City of Everett Official Use Only
<br /> / PERMIT
<br /> 77 ��jl�/�G � V1_4) \ L2 —06 Z_
<br /> Oner/Authorized Agent Signature Date (Revised 9/23/2016)
<br />
|