Laserfiche WebLink
PERMIT APPLICATIOI� <br /> �UILDItVG /MEGHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJEC7'SITE IFdFORMATIAN <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision t No. (attach copy of long legal description) <br /> CONTACT INF'ORMATION <br /> OWNER NAME: � pil� TENANT NAME(If Commercial): y� �i{�p � �,{/� <br /> OWNER MAILING ADDRESS: sTReeT �-09 j�I� � ,S' �/' <br /> CIIY Se,a, I STATE w� ZIP 9�I/� <br /> OWNER PHONE: a,�^ — 3/D OWNER EMAIL: �v1 yy�,yJ py1. ,� y1'i�ti��, Cp� <br /> CONTRACTOR NAME: Z � <br /> CONTRACTOR ADDRESS: sTRee-r 0 gd`I'�(AvL �L Iv� �' <br /> arv LQ k� S'f'�V�� STATE (� zia 7 p�.�� <br /> CONTRACTOR PHONE: 'a,Q6 - g -- �'7,3 7 CONTRACTOR EMAIL: �aw GJQ�.t � i1Y�A.t�r �p�/LL <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTIONOFWORK: C�.ay4s� y���: �-��� SCvl1GS� J - 3 �ov►�la�rfw�eyf S�%�k, �- mof s�r��� <br /> �,-- �Or�t�_ si,�l� <br /> ASSOCIATED BUILDING PERMIT# if applicabie): <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 #�f List of Fixtures #°f Lisf of Fixtures #�f List of Fixtures <br /> Fixtures Fixfures Fixtures 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&Disposai 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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 loca!law. The granting of a permif only authorizes approved work and no deviations theref�om.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> '" �" � � P�T�� "�V`�. <br /> Owner/Au orized t Signature Date (Revised 9/23/2016) <br />