Laserfiche WebLink
PERMIT APPLICATIi <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� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �C�� Oi, U e PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACY INFORMATION <br /> OWNER NAME: �j�p 7 �,/ , � '�j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREEr I��� ��lCk�1 `V-L <br /> CITY ��J-e� �"�'�'�� STATE W ZIP � ^�� <br /> OWNER PHONE: C��'J "• �r OWNER EMAIL: ✓" �/{- <br /> CONTRACTOR NAME: (j (� !'�(�x: �� ' <br /> CONTRACTOR ADDRESS: srReer I u; ' �� ,U'; <br /> CITY l STATE l.Q� ��'I� ZIP �(�j�I I <br /> /` n , <br /> CONTRACTORPHONE: `�I� � (p � CONTRACTOREMAIL: �Q�{-� {'�,�{'rl��✓1�- . C i/L� <br /> CONTRACTOR LICENSE#(REQUIRED): (�*�(L�j ' � (� CITY OF EVERETT BUSINESS LICENSE#(RE UIRED): S <br /> PRIMARY CONTACT: WNER ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: �L,{-� ��S�'� CONTACT PHONE: (� �, , � G�` � <br /> CONTACT EMAIL: � ' ) � ' ! <br /> � �.e, ('o�f,���t�,�i- � C��� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ � D � > <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: ,�e����� O L �W� l C#�.�'+'S 6 h rCC;t-.�'l� 1 v�S��l 1� �`^� CS7��`ti 1� ���`'��- <br /> J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #�f List of Fixtures #of List of Fixfures #°f List of Fi�ctures <br /> Fixtures Fiutures Fixtures Fi�cfures <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 Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �P�3SNb(LE�3/SIJPPttE�$SORI �X�'i'EIlA <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I l�ave 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 the�efrom.Deviations musf first be autirorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or(am authorized by the owner of this property to pe�fiorm the work for which application is made, <br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �� �� .—�/� ._ ,-�/ PERMIT � <br /> lG �e�( 0 5� <br /> �- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />