|
PERMIT APPLICATIO..
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER / 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@everettwa.gov� wwnni.everettwa.govlpermits
<br /> (Blue or Btack Ink fJnly Please) _ PROJECT SITE INFORMATION ��
<br /> ,� � _ . u
<br /> PROJECT SITE ADDRESS: �D'� ' ��' � �LG //�� PROPERTY TAX#: ! �,
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No.� (attach copy of long legal description) � ,',,,
<br /> fi ;�'
<br /> ,:.. ,'
<br /> CONTACT INFORMATION ,; ;i�;
<br /> OWNER NAME: i�,�1 TENANT NAME(If Commercial): �� t=��
<br /> / / !Gi l �1iV'-.,�
<br /> OWNER MAILING ADDRESS: srReer � a 5L �j� V�I2� G�IZ lC �-v��` � ,'y
<br /> � � �� CITV � STATE 1/��� ZIP J �l/� Ih�,� I!
<br /> i �
<br /> OWNER PHONE: - � � OWNER EMAIL: �; ;,� � � ', �j�!'/�JG�,�`',�(/, !{j/Y/ a
<br /> CONTRACTOR NAME: � , �' '
<br /> `j ,
<br /> CONTRACTOR ADDRESS: srReer �6// `� j yLa 1`��) j' � �
<br /> CITY STATE "`� `' ZIP ,�`, �� , i
<br /> �/ ,
<br /> CONTRACTOR PHONE: ���� -3 �3 a� LI-6 CONTRACTOR EMAIL: �,�27�iL � T�� , f . , �
<br /> CONTRACTOR LICENSE#(REQUIRED):#�� r�PI/ Q y G/�S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D�3S��
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) � �
<br /> CONTACT NAME: / CONTACT PHONE: ��� - C,( �L� — L( �( ��-- i� '
<br /> ��� � r ��� 'a�
<br /> � CONTACT EMAIL: �, ��l'- � ��� �,)f�:fr;c; � : (r' I 1
<br /> B'UILC►ING PERMIT APPLICATION ' ' Cu5%�,ra,�,,,. ,,c
<br /> Existing Use of Building: Contract Price of Work: $ � �'��'iC u'� n
<br /> �,
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other C�
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: II�Gommercial ❑Industrial �
<br /> �.
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use �
<br /> DESCRI, TION OF WORK: � �/ "�
<br /> (�/� �'�' ,���12� � G�i�� � '''���. � %L����G��J� �.
<br /> '`��� '(��� � ✓ �
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): b
<br /> C
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION �
<br /> Type of Project: _New Addn _Alteration Repair Type of Project: New Addn Alteration Repair �
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures �
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) �
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain �
<br /> Water Heater Refrigeration Shower Floor Drain �,
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposai Grease Trap `�
<br /> Gas Range Ducting ! Dishwasher Roof Drains �;
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas �
<br /> Range Hood Water Heater Other: c
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: �
<br /> SPRI N KLER,/SUPPRESS ION,SYSTEM Z
<br /> Chemical 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 I
<br /> current 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 from the
<br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett O�cial Use Oniy
<br /> PERMIT#
<br /> �`��'',/r'�-,�—�_ � �� C� ' . �J G.� -
<br /> r/Authorized Agent Signature Date (Revised 9/23/2016)
<br />
|