Laserfiche WebLink
I' f�I����1i' c�&�ff��9CA�'80Y� <br /> f��90�.�64� )�dE�G��.6�IC��./ f���9i��B�9�/��G�9/��R�h�Ge��6�/�[�Y�i0�,9�'90� <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� wv�nv.everettwa.gov/permits <br /> ���a�����9a�c��s��f���a9�P����e➢ i���dG�`�'��`�� B�l��l�f�/,�'�'9�� <br /> PROJECT SITE ADDRESS: �O,:L� �L���LL-�'� `�j PROPERTY TAX#:� Q �O�O�Z�C,/ <br /> LEGAL fornew construction: Short Plat/subdivision Lot No. (aftach copy of long legal description) <br /> ���e9`�'���ll 96�9��f��i8,�°�'9�� <br /> OWPlER NAfVIE: Q� TEIVANT 1VAME(If Commercial): <br /> OWNER MAILfIVG ADDRESS: sTReer a �L,. <br /> CIT' ��i vc� !T STA'fE ZIP� <br /> OWfVER PHONE: � OWIVER EMAIL: <br /> CONTRACTOR iVAME; � lVt �— �Lu w�f�►�lG� �-- �'��t--`�,� <br /> CONTRACTOR ADDRESS: srReEr � � �Q. �' <br /> ��7y ��y/'{���U� STATE � ZIP <br /> CONTRACTOf2 PHONE: �Z-�j=f�-�j�— L� COiVTRACTOR EMAIL: f3 �f('�!'f�j,iV( e <br /> CONTRACTOR LICEfVSE#(REQUIRED):���(I,S�}�C�1-F 1..� CITY OF EVERETT BUSINESS LICENSE#( QUIRED):��a�JL�- <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> COMTACT NAME: CONTACT PHONE: �'ZC�'�s,_ (,� <br /> � �� ���� � CONTACT EMAIL• ������ <br /> �UILDIl�1Cs �ERM97'1'�PPfl.ICA`�'HON <br /> isting Use of Building: Contracf Price of Work:$ O �S U� <br /> roposed Use of Building: � Heat Source: �as �Electric ❑Other <br /> Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family�#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New �Add'tion ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTIONQFWORK: �C���� �'x�S•.n1�� v�a�T�i� ��il�,C� �(^�'-� ,l�{l�//� ��{-,s <br /> 1„'_l�l�YV�'�-E �� -�/�INYL>� LE/��1 IU 1`,'� �V /l�-�w �S ����J'��i,,� . <br /> V <br /> ASSOCIATED BUILDING PERMIT#(if applicabie): <br /> ➢WEC6�AN9C,�►.L P�FtMI'B'd��P9.IGAT109� ��.11M�1!!�G P�RMHT AP0�L�9�AT00?d <br /> Type of Projecf: ^New Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #�f Lisf of Fixtures #°{ List of Fi�ctures #°f List of Fixtures <br /> Fixtures � Fix#ures Fixtures Fixfures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(lnside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Neater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Ciothes Dryer Hookups Other: Clothes Washer Medicai Gas <br /> Range Hood Water Heater Other: <br /> F�chaust Fan Sink(Service/Bar/Mop/efc.) Other: <br /> �1��9Gd&C���/S11����S�G�R� SYS'1'��/! <br /> Chemicai or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> �rrent 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 f�om the <br /> �rilding Offcral 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 /> —�d I comply with t6e Sfate Contractors Law 18.27 RCW and 296200A WAC. <br /> City of Everett O�cial Use Only <br /> PERM� /1 � 0 S� <br /> / /v� / v � <br /> Owner A orized Agenf Signature D e (Revised 9/23/2096) <br />