Laserfiche WebLink
IPERMIT APPLICATION <br /> 0.67-4 <br /> BUILDING I 'MRHANICAL I PLUMBING/SIGN /SiCLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www everettwa,gov(permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ZCp ,2. 5A'S G � ?Ve <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivislu i Lot No. (attach copy of long legal description) <br /> _ w <br /> OWNER NAME: $hA il.LIBAUGh TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.4012. EASTar,gANCo e. <br /> STATE Vti+'r-i 1. <br /> OWNER PHONE: 25 `Tito <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: dr <br /> CONTRACTOR ADDRESS: STREET . <br /> CONTRACTOR PHONE 1 a CONTRACTOR EMAIL: - " g = <br /> az)- <br /> CONTRACTOR LICENSE#(RECiLlit 3 '•• ; 4 t7 Cit',OF EVERETT BUSINESS LICENSE ff(REQUI EDO( O <br /> WU/PRIMARY CONTACT: ❑OWNERs <br /> $ "ONTRAcTOR ❑OTHER(Please Specify) <br /> CONTACT NAME :41,7 CONTACT PHONE: LIZ a I . <br /> CONTACT EMAIL: c4,1 Lira (-:i CSM <br /> BUILDING PERMIT APPLICA�TI.N <br /> Existin. Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building; Heat Source: ❑Gas galectric ❑Other, <br /> Building Type *FR- etaphed ❑SFR-Attached QDuplex ElMulti-Farnit4it of Units„ ❑Commercial 0Industrial <br /> T-pi of PrB`act: ❑New Z ddetiori ❑Remodel Q :..air DT,I„ QS'.n El orinkter ❑Demolition DC art,e of Use <br /> DESCRif?'tiON OF CO K <br /> • <br /> TV1 ll 1 irii 5 11+ teiectr pu.niv wrWi 12.xt2 room. -�b room vent' <br /> 12Nvhove avid cap wa U4- �t� i <br /> „ASSOCIATED BUILDING-PERMfT j hind bre ._: x.� ) .,..,,, ! . 5 'x_ 1!1»w .� „. �<, <br /> MECHANICAL PERMIT APPLICATION <br /> P1CiNG PERMIT 1PPICATION <br /> Type of Project New X Addn Alteration Repair Type of Project _New Addn _Alteration _Repair <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures #of List of Fixtures <br /> Fixtures <br /> NC—Air Handling Units I Heat Pump Toilet `Backflow Preventer Ineidealdgy <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 'Lavatory <br /> (Wash Basin Etr#inliirio Fountain <br /> Water Heater Refrigeration Shower <br /> aFloor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Gas Range Ducting Dishwasher Roof Dt ttris_ <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 /> ; !I IC,L I SPP 3I+ N—us <br /> TEM <br /> [Number Of HeadS <br /> ICKNOWLEDGEMENT: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 /> urrent 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 /> Wilding 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 /> nd I comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use f?nly. <br /> pERSM # Lc <br /> n <br /> i r/Auttlortzzed Agent Signature, Date 1 �� <br /> (I�'evised 023,26 113) <br />