Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ 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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �� C i ,�/ �o PROPERTY TAX#: l G�1 W� Z�� (GD <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long Iegal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � G �/' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer �Z�f' S <br /> CITY ��� STATE ZIP �� <br /> OWNER PHONE: Z�— P>gi— OWNER EMAIL: <br /> CONTRACTOR NAME; � <br /> CONTRACTOR ADDRESS: sTREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRE : / <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR (l�OTHER(Please Specify) <br /> CONTACT NAM : Q�'r ' M�LES � I�}GE� CONTACT PHONE: 2r� `L� � O�(%' <br /> ��jG'� �S� '� F'��Lt— /��R�i�T'EG�S CONTACT EMAIL: <br /> . � <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 /> T pe of Project: ❑New ❑Addition ❑Remodel ❑Repair �1T.1. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: �� ��1��5/ ��-f-�(,� ��DQ ,}. . �k�T I�vti�s �'O ���CR�ICE <br /> r'•C l ("-,� <br /> � I'�� l G� l NTb 7"�n,r 0 S c�i T�5. vn�► � <br /> �f/��� <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of �ist of Fixtures #�f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 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:1 have reviewed this application and confirm the information contained herein is true and correcL Work done pursuant to this permft must comply with <br /> current 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 /> Building OKicial before being authorized under any ciroumstance I am the owner,or I am authorized by the owner of this prope�ty to perfo�m the work for which application is made. <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �7 City of Everett Of(icial Use Only <br /> ,� /� PERMIT <br /> � ��__ e ��,i ,. G�( � o q�r��I✓ , <br /> �, <br /> nerlAut rized Agen ignature ate (Revised 9/23/2016) � <br /> �• �'�,,' <br />