Laserfiche WebLink
���!!�i 8T AP�LICA�'10�! <br /> ��99L�8�� /M��Hd4NICA�/ ��.,UVi��IG�� 1 SIG�9 l���9i��{�.��/ �f��01.V�lOY� <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 /> (�laae o��laels 1¢���n8y�lease) ���J��`i'SI`�'E iE����MW�I�� <br /> PROJECT SITE ADDRESS: � � �I..� �,�� � � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �Ot�`�'AC'� IN�'ORMA`�'9�Q� <br /> OWNER NAME: TEfVANT NAME(If Commerciai): <br /> OWNER MAILING ADDRESS: srRee-r <br /> � CITY " STATE � ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ��j"j�(� � <br /> CONTRACTOR ADDRESS: sTRee-r � <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CON'fACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> Bt7iLDING PERMIT APPLICATI�N <br /> Existing Use of Buiiding: Contract Price of Work:$ � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (1'l-�`v` � �Q I {�(� � �'l . F-`� ,1 • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECIiANICAL PERMIT APPLICATION PLl1MBiNG PERMIT APPLlCATION <br /> Type of Project: _New_ Addn AlYeration _Repair Type of Project: _New _Addn Aiteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #of List of Fixtures �°f Lisf of Fixtures <br /> Fixtures Fixfures Fixtures Fixtures <br /> A/C—Air Handling Units Heat 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 j Other: . ;�j�� Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BadMop/etc.) Other: <br /> SPRIN�CLER/Sl1PPR�S�IO�d SYSTEM <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 <br /> currenf federal,state,and local law. The granfing 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./am the owner,or I am authorized by fhe owner of this property fo perform fhe work for which application is made, <br /> and 1 comply with the Stafe Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Evereff Officia!Use Only <br /> r .;� , PERMIT# <br /> ��� ,�.-�'%7 �-����/��� <br /> O er/Authorize ��gent Signature Date (Revised 9/23/2096) <br /> � ��O lo- O�.-D <br />