|
PERMIT APPLICATION
<br /> BUILDING /MECHANICAL I PLUMBING /SIGN /SPRINKLER/DEMOLITION
<br /> CtTY OF EVERETT PERMIT SERVICES
<br /> 3200 CEdAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 j(E)everetteps@everettwa.gov� www.everettwa.govfpermits
<br /> .<, ti, , z,. a N �.�-y�,7��s .��r �a r�� sr �/ � �� rs �: -� ,
<br /> ' �a ,..� „��., .,. „ „ .�, ��.�5'fi� ., ,b .� ,.:,..� ����`a��-� �,. � s��t -,P..�� �wW "' �, ^�s � :. '`y f t-� �p
<br /> ,�s i
<br /> � � � + ��i e��i,� ti � � ° �G' ti '�i+�`� �rJ "�'fi�* e.,��` �,_ ` , ���,.c.. �.°��
<br /> e
<br /> PROJECT SITE ADDRESS: �yg�,,�I g�j�,'I�SI�/f�� ��, � ��PROPERTY TAX#: I�..�j9.Z�(90.��J ��J I
<br /> LE{'aAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br /> �` ��c £ -:r � � t �,�,{ t`1 S�:.s.. � '��T������7�}'O�l������, 4{a} , � .F , i .t _,
<br /> ?-.,s z ,V,. ,��°� 3 ,� u Fy��;,� r+ r � a #.,,� � �.
<br /> OWNER NAME: � �� � � �� TENANT NAME{if Commercial):
<br /> OWNER MAILING ADDRESS: srneEr � �, �� a�b
<br /> ��,� A [t �. ��c STA� �,�4 Z�P 9�'� .�
<br /> OWNER PHONE: �.S ,2gD-��y�5a OWNER EMAIL:
<br /> ,. _ �,. . ...w.., �. . . . ..�. ,w. . ._ M �.,_ ., .,__ . .. _.�. ,.. .. .., ...,. �.. � . ___.
<br /> CONTRACTOR NAME: � � ��
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE 2�P
<br /> CONTRACTOR PHONE: CONTRACTQR EMAIL:
<br /> CON`�RACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE�(REQUIREd):
<br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR� ❑�OTHER(Please Specifyj
<br /> CONTACT NAME: CON7ACT PHONE:
<br /> CONTACT EMAIL:
<br /> s�� " i rr .� x: z � � :�r ' r � ' y� �y y � * r .�:^y� y �,�,x t� g ,� � ,:.� ,�.
<br /> ., ,�A A b: �,:�f �� ��i'l,'.��I�������I���Y'^���M���A�l��� r` k ,Y,., .���?" ; i fw
<br /> .�� �, xn.,�..�rN tQ.
<br /> �. � ,�: .�.. � �„ «�., ,.�.. .�, .r.,,. R ,�. ,>� .,,� � 1. .. �.., � , ... .r.., ,. .._,
<br /> Existing Use of Buildin : �f� Contract Price of Work:$
<br /> Pro osed Use of Buildin : ��-1� Heat Source: ❑Gas lectric ❑Other
<br /> Buiidin Type: ❑SFR-Detached ❑SFR- ttached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial
<br /> T e of Pro'ect: ❑New �Addition Remodei Repair �T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK: ��MO��L ('��``L�.(-��.�~N�j 3�7fr-2�� • �t.P/Q(2. L.EO�'1�'C[lJFj �-1 X�"Uf2t�s
<br /> R��a su���o�,Q. . � �, �
<br /> N�w ���- ,�v��— u� :
<br /> ASSOCIATED BUILDlNG PERMIT# if a licable: �7 ����
<br /> , ....III,IE��;#�;1!4��,1�`L�,P�RIIAI'�''AP;P�t��ll�"���< . ,M,.�: > ,... . ,,.;. `` ,..... .,�"�tt111��[I�i�.P�R�#"�'1�KR���'��� ;.....} .,, `,
<br /> Type of ProJect: �New Addn Alteratlon _Repair Type of ProJect: ,_New Addn �Aiteration �Repair
<br /> #of Lfst of Flxiures #°f List of Fi�rtures #°f Llst of Fprtures #of list of F(xtures
<br /> Fixtures Flxtures Fi�rtures Flxtures
<br /> A/C-Air Handlin Units Heat Pump � Toilet Backflow Preventer Inside Bld )
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Pipin Boiler � Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refri eratian Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Ran e Ductin Dishwasher Roof Drains
<br /> Clothes D er Hooku s Other: Ctathes Washer Medical Gas
<br /> Range Hoai Water Heater Other:
<br /> Exhaust Fan Sink Service/Bar/Mop/etc.) Other:
<br /> � ���������r�lR���!�.M�� � ����#�c,�. ..,
<br /> �
<br /> Chemical or Water No.of Heads
<br /> ACKNOWtEDGE'MENT:!have reviewed this appllcation and confirm the infomiafion contained herein is true and correct Work done pursuant fo this permft must compiy wlth
<br /> cunent federal,state,and loca/law.The granting of a pertnit only authorizas approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> 8ui/ding Off'icial 6efore being authorized under any circumstance.f am the owner,or!am authorized by the owner of this property to perform the waic for which application is made,
<br /> and l comp/y with the State Contractors Law 18.27 RCW and 296.ZOOA WAC.
<br /> City of EvereK O�ciaf Use Only
<br /> �— �� `p/ " I�- PERMIT# � ������D
<br /> OwnertAuthorized Agent Signature Date ( evised 9/23/2016) �
<br /> �
<br />
|