Laserfiche WebLink
PERMIT APPLICATION <br /> /OW <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (.(E)everettepa verattwa.gov1 www.everettwa.gov/permits <br /> Blue;<or'Black Ink Only Please) "--0:EC.it ii "' + '£t , `( <br /> PROJECT SITE ADDRESS: -fir <br /> I„iS. eteigeh, FL <br /> sE _ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision .. Lel No. (attach copy of long legal description) <br /> , <br /> 'COtlitAtit NFO , titill <br /> OWNER NAME: # ki 0,! 1 A TENANT NAME:(i Commercial);:: <br /> OWNER MAILING ADDRESS: STREET sa,'' 'L! :•K <br /> CITY STATE ZIP <br /> OWNER PHONE <br /> 425 4 1, 9 OWNER EMAIL: <br /> CONTRACTOR NAME: yy <br /> CONTRACTOR ADDRESS: STREET Lk1 d <br /> c _ y J <br /> CnY STATE w ZIPf�� ): <br /> CONTRACTOR PHONE 2.5 O CONTRACTOR EMAIL: {iI t h t~ �., <br /> t <br /> CONTRACTOR LICENSE INREQUIRED~Cm Vita t 17d f dITY OF EVERETT BUSINESS LICENSE 4,0111ti t ' <br /> cta <br /> PRIMARY CONTACT: O OWNER WI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE LIZ <br /> CONTACT EMAIL: ,� <br /> Existing Use ofBuikftn Contract Price of Work:$ . . <br /> Proposed Use of Buildings Heat Source: OGas ; to trric, DOther <br /> Building Typo, . FR-Detached OSFR-Attached ODuplex 1:1MuItt,Famii0 of Units. OCommercial Dindustrial <br /> Te of Prtrect: ONew ❑Addition DRemodel OR:;ortCr OT,I. LIST 121&briniditr ❑Demolition }'Chante of Use <br /> DESCRIPTION OF WORK. I ;. . <br /> iVI S5t U. {n o P4A1419 q1-CU r hetlidit.r. <br /> ASSOCIATED BUILDING PERMIT#,:(tfjppte) <br /> MEcsAKI ,r. . WA 0,41cATIO$ PLUMB OLUMBINGt-EtROOT APPLICATION <br /> Typeof Project _New Addn Alteration _Repair Type of Project _New Addn _Alteration _Repair <br /> #of,_ #of ' #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures, Fixtures <br /> SNC—Air Handling Units^ i Heat Pur Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit <br /> Gas Piping Boiler Lavatoy(Wash Basin) Drinking Fountain <br /> Water Heater <br /> Refrigeration Shower 5hower FloorDraln <br /> Gas Fireplace P Wood Stove °Kitchen Sink&Disposal Grease Trap <br /> Gas a"ange Dtt Dishwasher Roof Drains , <br /> Clothes Dryer Hookups j Ofte L " Clothes Washer Medical Gas <br /> Range Hood <br /> g Wafer Heater.... Other:. <br /> Exhaust Fan Sink Service/Bar/Mo./etc.4 OtheP <br /> SPRINKLER,1SUPP".` IC0, SY , <br /> Chemical or Water JNo ads <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.Deviellons must first be authorized in writing from 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 t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �, `PERMIT <br /> 7•12•i? �► Y \ <br /> 'f3wn9/Authorized <br /> Agen lgnatnre: Date (Reursaa_9123t40'f <br />