Laserfiche WebLink
PERMiT APPLICATIO(� <br /> BUiLDIt��I-I�IECHANiCAL I PLUMBING!SIGN �INKLER/DEMOLITION <br /> CITY OF EVERETT PERMfT SERVICES - � <br /> • 3240 CEDAR STREET,EVERETT,WA 98201 - <br /> {P)425-257-881 U � FRX 425-257-8857 �(E}everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PR4JECT SITE tNFORMATiON <br /> PRQJECT SITE ADDRESS: 1 �� � q, �f p., �(p� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/su6divisia� Lot No. (attach copy af long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: w lp�� E? TENANT NAME(if Commerciai}: � t; (n� 5 <br /> OWNER MAILING ADDRESS: s�er <br /> CI'K (' V � STATE W� ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �� �y h " V ' <br /> CONTRACTOF2 ADDRESS: s-rReEr (�p ZJ 2 �+- ^V��( ��� <br /> �� rn►r� STA,� �r� vP �s6�a <br /> CONTRACTOR PHONE: y Zs, �j CONTRACTOR EMAIL: �`j l. i^►��►�<Sf 1• CQ►�1`'j <br /> CONTRACTOR LICENSE#(REQUIRED): ��j��)5 q�Q�� C1TY OF EVERETT BUSINESS LICENSE#(REQUI ): OS S I d <br /> PRiMARY CONTACT: �OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �(A1f1K G�On71a-�S CONTACT PiiONE: 1-fZ,s'.�?�,�j b6 <br /> CONTACT EMAiL: �jj�-�,� �s�,mSY"):CCI'i'"Yl <br /> BUILDING PERMIT APPlICATION <br /> Existing Use of Suildin : �,f3 t'Y1 i��lC.{� Contract Price of Work:$ <br /> Proposed Use of Building: N�1at Neat Source: ❑Gas ❑Electric Ofher <br /> Building Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: Commercial �industrial <br /> Type of Pro'ect: ❑New �Addition ❑Remodel C1Repair �T.i. �ign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ►ns��� dne LEfl CY�aanr�� le� a�s�p�ay . <br /> ASSOCIATED BUlLDING PERMIT#(if ap licable): <br /> MECFIANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: �New Addn Aiteration Repair `fype of Project: _New _Addn iAlteration �Repair <br /> #of Usi of Frxfures #Qf List of F"rxtures #�f Lisf of Fixfures #°f List of Fixtures <br /> Fixtures Fi�ctures Fixtures Fixfures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg} <br /> Forced Air Systems Unit Heater - Bafhtub Urinai <br /> Gas Piping Boi(er Lavatory(UVash Basin) Drinking Fountain <br /> Wafer Heater Refrigerafion Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposat Grease Trap <br /> Gas Range Ductin Qisfiwasher Roof Drains <br /> Clathes Dryer Hookups Othee Glo#hes Washer Meciicai Gas <br /> Range Hood Water Heater Othec <br /> Exhaust Fan Sink(ServiceBar/Mop/etc.) Other: <br /> SPRINKGER/$UPPRESSION SYSTEM <br /> Chemicai or Water No.of Heads <br /> ACKNOWLEQGENIENT.•I have revlewed this application and confirm the information confained herein is true and correct Work done pursuant to fhis permit must cromply with <br /> current federal,state,and local law.The gran6ng of a permit only authorizes approved work and no deviations therefrom.Deviations musf firsf be authorized in writing from the <br /> Buiiding Official before being autho»zed under any circumstance.I am the owner,or t am authorized by fhe owner of this property to perform fhe work for which application is made, <br /> and 1 comp/y wHh the State Contracfors Law 98.27 RCW and 296 200A WAC � . <br /> Cify of Everett Officia/Use Only <br /> �`�• � PERMI # ��� ` D� � <br /> Ow er/A horized Age f Sign ure Date {Revised 9/23/2016) <br /> � <br /> z <br /> r; <br />