Laserfiche WebLink
PERMIT APPLICATION <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@evereriwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: l�,�� �'�(� �G�l'.(� f C1�:�e� w PROPERTY TAX#: �� � ��-`�C�Z'U����� <br /> LEGAL for new consVuction: Short PlaUsubdivision �.�- ` Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ����r��..� f��/ TENANT NAME(If Commercial): -- <br /> OWNER MAILING ADDRESS: sntEeT �j�� ('j �- 1 '( � <br /> ciN �P Q/V vC.Q srA� L ziP ��SI�Z' <br /> OWNER PHONE: � � � OWNER EMAIL: l�� " ` �t �7��� I C� _ <br /> CONTRACTOR NAME: (� ( G G���`��� � "� � c � . � �� <br /> CONTRACTOR ADDRESS: srReEr <br /> arv srnrE zia <br /> CONTRACTOR PHONE: � �S� 3� . -�� � CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ��� Contract Price of Work: $ l � `� <br /> . <br /> Proposed Use of Building: /2'1 C�(.(, Heat Source: ❑Gas lectric ❑Other <br /> Building Type: � R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industriai <br /> Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: n + n � -�1 <br /> � ,/ k—�2�iM-�"�c�'I,YJ �V�-C�-cK cn ���,^I.�� W � �11� ��,L�'�2-�- � <br /> ��.l.�l.'� �P/y��,�C.L'L�+/�1 � (�(.'�..� 2-v�- Cr�-C^�l �1.�' 1� �-e ,i.�� ��11 c k'"�/�.�,,,,� v;:, <br /> `"I '( _ � <br /> �'�Z°�'�'\ 22''7�2�'1 �ZL ��h.£�4.���-�� l <br /> ASSOCIATED BUILDING PERMIT#(if appficable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPL ATION <br /> Type of Project: _New _ Addn Iteration� epair Type of Project: _New _Addn Iteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fi�ctures Fixtures List of Fixtures Fixtures List of Fixfures Fi�ctures <ist of 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 Z Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink 8 Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood � Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Other: <br /> SPRINKLER/SUPPRESSION 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 /> 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 irom the <br /> Building Official before being authorized under any circumsfance.1 am the owne�,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the e Contractors Law 18.27 RCW and 296.200A WAC. <br /> `. - City of Everett OSicial Use Only <br /> PERMIT# <br /> , , �� �� � ztir } � '� l �� <br /> Owner/A g t Signature Date (Revised 9/23/2016) <br />