Laserfiche WebLink
S <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING /SIGN I SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT.WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 j(E)everetteps a©everettwa.gov j www.everettwa,gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION t` <br /> PROJECT SITE ADDRESS: /06/Al 1,716pgSE giggEff art 20$ PROPERTY TAX# <br /> LEGAL for new construction: Short Plat/subdivision__ _____Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ho 4bion TENANT NAME(If Commercial) <br /> OWNER MAILING ADDRESS: STREET 9 , <br /> CITY <br /> OWNER PHONE: '2-5-•Ott- OWNER EMAIL: 'v - 2 <br /> CONTRACTOR NAME coov STY'N i i jN /Nc <br /> CONTRACTOR ADDRESS: =TREE 17621 /tT tive,0 t <br /> ilii ._ .. -. <br /> zip 9.404z. <br /> :ONTRACTOR PHONE: - _ I° if CONTRACTOR,EMAIL: ",' a►:° 112, ALA.&r7 '/ , ,.Car» <br /> :ONTRACTOR LICENSE#(REQUIRED): aheivEitfr/P../../C472: CITY OF EVERETT BUSINESS LICENSE (REQU(R€Q):: 0336-6 <br /> 'RtMARY CONTACT: 0 OWNER C►rGrONTRACTOR 0 OTHER(Please Specify) . <br /> :ONTACT NAME: :CONTACT PHONE: 126-""/8?_p/// <br /> kiOFF <br /> gcci -' ONTACT EMAIL' 1.4& }`2 tt3F ' . <br /> BUILDING PERMIT APPLICATION <br /> xisting Use of t3€f tdiincr+: Contract Price of Work:$ I i <br /> roposed Use of Building Heat Source: ❑Gas . DElectric DOther -.._ <br /> iuitdin Type; SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Fomitt#of Units: , ❑Commercial [Industrial <br /> -y e of Project ONew ❑Addition ❑Remodel DTI, °Sign Cl sprmklef ❑Demolition OChange of Use <br /> )ES�CRIPPTIION�OF WORK: ` ' <br /> f 'T ! em ou .. ori M 0:l7 �t--4/ <br /> ►SSOCIATED BUILDING PERMIT#(if applicablet., <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: New Addn Alteration Repair Type of Project: _New `Addn Alteration Repair <br /> °Ixtures List of Fixtures List of Fixtures of List of Fixtures #of List of Fixtures l: <br /> 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 9 '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 /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads <br /> CKNOWLEDGEMENT: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 /> rrrent 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 /> aiding Official before being authorized under any circumstance;,t am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> rd I comply with the State Contractors Law 18 27 RCW and 296..200A WAC. <br /> City of Everett Official Use Only <br /> PERM <br /> _ w 2 e ISo2 - CO3 <br /> wrier Aut prized Ag-e, Sigrtattt rt Date (Revised Si2O 20 9f) "` <br />