Laserfiche WebLink
,� � PERM17 APPLICAI'ION <br /> BUILDINC�ECHAMICAL 1 PLUMBING/SIGN / U��IftIKL.ER! 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@evereftwa.gov� www.everettwa.gov/permits <br /> (Bltee or Black Ln�Only Please) PROJECT S1Y� 1[�FOEtM/�iT10A! <br /> PROJECT SITE ADDRESS: �..�� ' � �. '�' �� PROPERTY TAX#: �,�JQ'S�I�D� J(���Ql� <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> GOIdT/4,C7'IMFORMATIOM <br /> OWNER NAME: ��Q� (���f �. �`(,fi j}� , TENANT IVAME(If Commercial): <br /> OWNER MAILING ADDRESS: sraeEr �'j �j �'� <br /> CI7Y �"��� . . STATE �� ZIP .� c ��� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T�� <br /> CONTRACTOR ADDRESS: srReEr <br /> CfIY � STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �Z j�- 2�`"3 .. � ` ''��j p y,1�, <br /> �-?ti�;� � �y'—'�� CONTACT EMAIL: ,�—�.�,�.�t , � � .�� � , � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 3-rvi� �}S' Contract Price of Work:$ � ��('.�"' <br /> Proposed Use of Building: Sfj-rv�E Heat Source: ❑Gas ❑Electric ❑Ofher <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: ❑Commercial ❑lndustrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑5prinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: „ „ ; , � c� u �,� <br /> � ��� �E--��- ���,,,,.. � � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): g(�O'J'� � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #�of Lisf of Fixfures #of ��st of Fixtures �°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside B(dg) <br /> Forced Air Sysfems Unit Heater Bathtub Urina! <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 /> Clofhes Dryer Hookups Other: Clofhes Washer Medicaf Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BadMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confrrm the information contained herein is frue and coaect.Work done pursuanf fo this permif must comply with <br /> currenf federal,state,and loca!law.The granting of a permif only aufhorizes approved work and no deviations therefrom.Deviations musf frrst be aufhorized in writing from fhe <br /> Building Offrcia!before being aufhorized under any circumstance.I am the owner,orl am authorized by the owner of fhis properly to perform the work for which application is made, <br /> and l comply with the Sfate Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Evereft O�cial Use Only <br /> ` � � �'^' � � PERMI #� G D�� �� � <br /> Owner/Authorized Agent Signature Date (Revised /23/2016) <br /> �/ <br /> rG <br />