Laserfiche WebLink
4����d9�'A��L9C�+�"904� <br /> �U9L�9N(9 I i�i�C�A�ICAL./ ��L1�6�1�� 1�IGi�4 /���6YV�aL�Q�/ ���4@OL.B�IOP� <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� www.everettwa.gov/permits <br /> (�lue o��iaek 6a���n6y�9e�se) ������T�1�'� 9N����/IA`�'�O� <br /> PROJECT SITE ADDRESS: �j '� �..� �y `�[ PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �OtV7'�C`➢' IIdF�RIViA'�'I�B� <br /> OWNER NAME: TEfVANT NAME(If Commerciai): <br /> �WNER MAILING ADDRESS: sTaEEr <br /> � CITY ' � STATE � ZIP � <br /> OWNER PHONE: OWNER EIVIAIL: <br /> CONTRACTOR NAME: '�'[`j (i � � . <br /> COiVTRACTOR ADDRESS: s-rReer �a <br /> CI"fY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICEIVSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONi'ACT: �OWNER ❑CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 3 S�� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> G���� � �Ua ���' �-� C� . � . <br /> � <br /> ASSOCIATED BUILDING PERMiT#(if appiicable): <br /> MBCHANICAL PERMIT APPLICl4TION PLUIM�ING PERMIT/�1PPl.lCA'T10N <br /> Type of Project: _New Addn _Alterafion _Repair Type of Project: _New _Addn Alteration Repair <br /> #of List of Fixtures #�f Lisf of Fixtures #of /rst of Fi�ctares #of Lisf of Fixfures <br /> Fixtures Fiactures Fixtures Fixfures <br /> A/C—Air Handling Units Hest Pump Toilet Backflow Preventer{Inside Bldg) <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&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups � Other: Qj�� Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink{Service/BarlMop/etc.) Ofher: <br /> SPRINiCLEtt 1 SUPPRESSlOIy SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMEIVT.•1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> currenf 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.l am the owner,or l am authorized by the owner of this properiy to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> a �� ,f <br /> i'r%--� i� ��/ ���� � PERMIT# <br /> � <br /> j ! <br /> O er/Authorize • gent Signature Date (Revised 9/23/2096) <br /> IrY1 l�-oCo - d 2 ( <br />