|
�3��C • �
<br /> PERMIT APPLICATION
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (�)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov( www.everettwa.gov/permits
<br /> (B��e or IBlack In�c Only Please) PROJECT SITE 1NFORMATION
<br /> Pi20JECT SITE ADDRESS: � � PROPERTY TAX#: � 1
<br /> LEGAL for mew constr�uction: Short PlaUsubdivision Lot No. (attach copy of long legal description) �--
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ; � TENANT NAME(If Commercial): C_ ,����
<br /> OWNER MAILING ADDRESS. sraaeeT – �
<br /> CIIY STATE ZIP� � �
<br /> OWNER PHONE: � –f„ OWNER EMAIL: ti, '� -
<br /> CONTRACTOR NAME: , 'a � ;S
<br /> CONTRACTOR ADDRESS: srneeT �(p(j� S 1 �{�'�
<br /> CfT'Y / STATE �,' ZI �`�
<br /> CONTRACTOR PHONE: � �- � CONTRACTOR EMAIL: I � p � r
<br /> CONTRACTOR LICENSE#(REQUIRED): �� � �f�� CITY OF EVERETT BUSINESS LICENSE#(REQ IR ):d\�
<br /> PRiMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify)
<br /> _ . _ , __– –,___ -
<br /> _ CONTACT NA14fE _-- _ _ __– —--- -- _ =�-ONTA�PHON�:`-- -- �^ --
<br /> _- �J :�C.�
<br /> ` i � CONTACT EMAIL: -�` � �
<br /> � cS �� .
<br /> BUILDING PERMIT APPLICATION
<br /> �C..:r+:..n 1 Ir....F Q��il.��..... f^,...4�....4 Ow:......i�Alw.L.Q �--
<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 /> - -- __ __. � -- –
<br /> ,,.,,....._r „,..,..,.�.., „,___.. . ,. , , ,. ._._. , ....__._...,_.. -: .____...._._ . :.
<br /> iypeotNraaect: �ivati� L1r�uuWvi� ui�oinvuc� ui�cNa�i u.nyn u.,Nn -;;y„ - "
<br /> DESCRIPTION OF WORK:. / � ,
<br /> �-���� �'V�-(�,�, w�"����u �.�.�..�-,
<br /> If.�flGlfl��'vf1 ��l1'L�C� C� �o�Jc� �1-(-t�J ���`L,U��r Cj—� �� ` "�(j`�— J l�
<br /> I �J��
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): C ) ������ ��SC��at.G�D ��1�fJS.
<br /> MECHANICAL PERMIT A LICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _._____New _ Addn Alteration _Repair Type of Project: _New _Addn _Aiteration _Repair
<br /> Fi tu es List of Fi�rtures Fiutures List of Fixtures Fixtures List of Fintures Fi tures List of Fixtures / �
<br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer�(.lns'ide Bldg)
<br /> Gas Fiping Boiler Lavatory(Wash Basin Drin � ountain
<br /> Water Heater Refrigeration Shower oor Drain
<br /> Gas Fireplace �UVood Stove Kitchen Sink&Disposal Grease Trap
<br /> �as Kanye uuctiny - uisiivvasi�er - of urains
<br /> Clothes Dryer Hookups Other: Clothes VIlasher Medi Gas
<br /> Range Hood Water Heate Other:
<br /> Fvha�ict Fan Cink (Ga ira/Rar/fiAnnlatc 1 k(lthar-
<br /> � L_
<br /> SPRINKLER/SUPPRESSION SYSTEM � y
<br /> Number of Heads
<br /> �1CKNO WLEDGEMENT:1 have reviewed this applicafion and confirm the information contained herein is true and correci. Work done pursuant to this permif must comply wifh
<br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations fPiereirom.Deviafions must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.t am the owner,or I am aufhorized by the owner of this property to perform the work for which applicafion is made,
<br /> -,.,.+i......,.,�„,.,;�ti�tio cs��o r...,r.���,,.�i�.,�R 97 17CIA/a.,.r ooa�nna iniar
<br /> � _.. ;�t„..F e,,...,.0 ner:..: ..
<br /> . . . _,i._.,.._.
<br /> � : �... �.,...:�...:......_., ..... ..
<br /> �., . \
<br /> r PERMI � Q�� ��
<br /> ��
<br /> . zecl i�yenc Signature iJa {Keviseo yi�;ti�uib/
<br /> � �`1
<br /> Z
<br />
|