Laserfiche WebLink
PERMIT APPLICATIOt <br /> eLlir4 <br /> j 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 gtZNj <br /> PROJECT SITE ADDRESS: `I( t-\Pch..v0.5 h , N S A7 ea t3.'T IM$ROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 L) £J, (LC- TENANT NAME(If Commercial): J O+lA r.- ASt.a S f{ate <br /> OWNER MAILING ADDRESS: STREET 'Z'Z-\0 LAC uJ� . A 4a p <br /> CITY e•SC L2C. STATE Wbl ZIP ` V -7-'J I <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: U.�cr`t4 'ViQ- 5Y$1Wk.S y <br /> CONTRACTOR ADDRESS: STREET nI/D 6 ,S ct 1-t1 A� /� f, <br /> CITY is A c 1"l"� STATE V�1 A_ ZIP 9 0,4.2_1, <br /> CONTRACTOR PHONE: ^3^2 4 8- 6-4 CONTRACTOR EMAIL: ,5V-0:,(2_,g,<: S —'<.EA ?-,'ILE: .C�....N. <br /> CONTRACTOR LICENSE#(REQUIRED): 5M\( 'F. ( Pc. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): z3 J 2- <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 24-3 — Z`t " 2"6 <br /> SGo-i .) CONTACT EMAIL: S 7.-e:f— 5 \i•t-k ems.. 4-. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i' ---6-Ns-TAN- A c-L=Al1 ACS�>-1'C S y5 I:3- 5;7.•x5.; it„ e,„__ -c.oNn- 'i Th p0J.c t\--01--, <br /> o L sty . <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 /> NC—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 <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SP LER/SUPPRESSION SYSTEM <br /> I Chemi :I or Water I No. of Heads <br /> ACKNOWLE c, MENT: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. T •gran g of a permit/, ly authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being author'ed under:ny circumstce.1 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 Cont:dors Law 1:.27 RCW a/.296.200A WAC, <br /> City of Everett Official Use Only <br /> ii— Q PERMIT# <br /> 1� rif( - 001 <br /> Owner/Authoriz-d Agent Signat >• i Date (Revised 9/23/2016) <br />