Laserfiche WebLink
P�RNi9T'A��LIGATLOf� <br /> �U9L.D99�G /�IECHAP�ICAL/ ��.11V��IP�G /�IG�! /�PRB�VGa�ER/ �Ei�01.9�"IOi� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everetfwa.gov� www.everettwa,gov/permits <br /> ��6a�����I�c� S�tk OnLy�Le�se) ������`�'��T� 9R9���6VIA°�'1�� <br /> PROJECT SITE ADDRESS: � � , �.� t� v l� � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �Ot�'TA�'P' IQdFORM/4�'L��! <br /> OWNER NAME: TENANT NAfVIE(If Commerciai): <br /> OWNER MAILING ADDRESS: sraeEr <br /> � � CITY ' � STATE � ZIP <br /> OWNER PHONE: OV1/IVER EMAIL: <br /> CONTRACTOR NAME: '�j�(tj/��/J <br /> CONTRACTOR ADDRESS: s-rReer <br /> ��7y STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> GONTRACTOR LICEIVSE#{REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CON7'ACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUIL,DING PERMIT APPLICA7ION <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 ❑Dupiex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1 �od ���� �-� � � b�'� � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICA7'lON <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 List of Fixtures #°f List of Fixtures <br /> Fixfures Fi�ctures Fixtures Fixfures <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 Fioor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clofhes Dryer Hookups j Other: ;}j)� Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRIDIKLEI3/St1PPRES�lON SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMEIUT.�!have reviewed this applicafion and confirm the information contained herein is true and correct Work done pursuant to this permit musf comply with <br /> currenf federal,state,and locat law.The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must first be aufhorized in writing from the <br /> Building Otficial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of fhis property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everetf Official Use Only <br /> � <br /> ' PERMIT <br /> i , ��� '�`/������ . ^ <br /> O er/Authorize gent Signature Date (Revised 9/23/2016) <br /> @M t�0 (� — O� g <br />