Laserfiche WebLink
PERMIT AFPLICATION <br /> BUILDING�CHANICAL/ PLUMBING !SIGN I` NKLER/ 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 On1y Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ZD PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot Na (attach copy of long legai description) <br /> CONTACT INFORMATION ' <br /> OWNER NAME: , /y� ' � a... TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rRee-r <br /> CI'fY " STATE ZIP <br /> OWNER PHONE: � � v - �4� � ! c'f OWNER EMAIL: �,���c ,� . G �� C�� l�(C�- /'�.(P� <br /> CONTRACTOR NAME; �- ���E����-' r, �G� L <br /> CONTRACTOR ADDRESS: sTREer t� �c� �.,i-!(o/2� �} � N <br /> CITY �! {tp� �l�/�.Ga STATE �/"' ZIP � ` � <br /> CONTRACTOR PHONE: p� � 7 CONTRACTOR EMAIL:C✓� �/d�/�(�L /�� �r�/��. -„��, � <br /> CONTRACTOR LICENSE#(REQUIRED): � �?j�V/� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ` o � �jr <br /> �7GI`g�'�o �aQN 7"/� 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 ❑Industria! <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �C�� � L(� ����z5�y S TG�� c���r� <br /> C <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fi�ctures #�f List of Fixtures #of Lisf of Fixtures #of List of Fixtures <br /> Fiufures 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(Vllash 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this applicafion and confirm the information contained herein is frue and correct Work done pursuant to this permit must comply wifh <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be autho�ized in writing from the <br /> Building O�cial before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> /��'L/� � � �_/p —�� PERMIT ���� <br /> Owner/Authorized Agent Signafure Date (Revised 9/23/2096) <br />