Laserfiche WebLink
PERMIT APPLiCATION <br /> BUILDING / MECHANICAL/ PLUMBiNG / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERPv91T SERVICES <br /> 3200 CEDAR STREET. EVERETT,WA 98201 <br /> fP)425-2�7-8610 ( FAX 425•257-8857 �(EI everett�>p�`�-e�:erettwa.yov� www.evereFtwa.gov/permits <br /> (81ue or Biack fnk Only Please) PR+DJECT SITE INPgRMATt(}N <br /> PROJECT SITE ADDRESS: ` ' PROPERTY TAX#: <br /> LEGAL for new constn�Gion: Short PlaUsubtlivision________._,..__._,_ Lnt Nn._____ lattar..h cr�py ot Inny Ieyai d<-sc:rfptit�r�i <br /> CClNTACT iNFORMATEON <br /> OWNER NAME: ' • TENANT NAME(If Commerciai): - `' <br /> OWNER MAIIING ADDRESS: sTkter <br /> CITY � '�It�f: � LIV � <br /> OWNER PHONE: OWNER EMA�L: <br /> CON7RACTOR NAME <br /> CONTRACTOR ADDRESS: ,,�.r=- <br /> .a,v :��in,[. ,,N . - <br /> CON7RACTOR PHONE: CONTRACTOR EMAIL: <br /> COMTRACTOR UCENSE#fREQI?IhED;: CITY��EVERETT BUSINESS LICENSE#(REQUIREO): ' ' <br /> PRIMARY CONTAC7: p OWNER �C(�NTRAC[OR ❑OTHER(Please 5pecify)�____.._________!,_v____ <br /> CONTACT NAME: CONTACT PHONE; <br /> , CONTACl"EMAIL: �^i __ ____� - <br /> BUILDING PERMIT APPLICATtON <br /> Existin Use of Buildin : Contract Price of Work:$ <br /> Proposed Use o1 Buiidin : Heat Sour�e: ❑t�as Electnc ❑ her <br /> Buddin T pe ❑SFR-Detached ❑SFR-Att�ched ❑Dupiex �Mufti-Fami! -##af Uniis. ❑Co nerctal ❑Industriai <br /> T e of Pro'ect: ❑New I�Addition ❑Remocfei ❑Re air ❑'T.L C7Si n ❑S rinkler ❑ oli ❑Chan e of Use <br /> DESCRfPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#tif applical;le): <br /> MECHANICAL PERMlT' APPIICATION PLUMBING PERMIT APPI.ICATION <br /> Type of ProjecY New __ A<idn __Alteration ___Repai� Type of ProjeGt: New Addn Akeration Repair <br /> #�f tist of Fixtures #of ��st of Ffxtures ��� List of F(ztures #°j List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air li�ndlin Units Heat Pump Toilet Backflow Preventer(Insid�:Str�q) <br /> Forced Air S stems Unit Neater BathUib Urrnal <br /> Gas P�pin E2oiler Lav<itcry('v^Jas�E3asinj Drinki��g Fcw�tain <br /> Water Heater Refri eration Sh�wer Floor Dram <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes Dr er Nookups Other Civihes Vvasher R4edicai Gas <br /> Ran e Hood W.�ler Nc:�jter �7tiier. <br /> Fxhaust Fan Sink(Service/Bar/Mo letc. Othec <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemical or Water Ro. c(!-ieads <br /> ACKNC�WLEDGEMENT I heve rev�ewed this apphcalion and conbrni the mlormation contained herein�s 1ru�and correcL Wortr donel pur.�;u:�n;t.n this p�,�rnit rnust c eanply wifh <br /> cunent lederal,state.and local law The yrantmq u/H�ieimit��nly authonzes apUroved waR and no devietions thereirom Deviations must brst bo author�zod in wrding fr,>rn thu <br /> Eiuilding dfficir�l belore beinq euthorrzed under any�:ur,umstance.I am the owne�,or!am authonzed by the nwnar o/this propeRy tn peAorm the work for which applicatinn is madr. <br /> r+nd 1 comply wrth the State Con[rricfors Lew 18.27 RCW ai�d 296.200A WAC. <br /> C�ty nl F.Fvereff nflirval Use Onfy <br /> . P�Ti - '1 <br /> r <br /> Owncsr/A�rthoriaed Agent Signature Date (Rnv�seu 9/2:?/201r;} <br /> 4 �� <br />