Laserfiche WebLink
PERMIT APPLICATION <br /> "IIIP'4414 .--A BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:gR- 3'7- ) ©` ' 1R.. Se_ &feryQA lAl1L\ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: \Ac pn ke,cip_kcoMae TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET g`-} 17 I u`w` SE <br /> CITY UJ-erLeck ' STATE 41.4 ZIP q�2©g <br /> OWNER PHONE: 2-& .jO G ;p 4.6 c OWNER EMAIL: �'��l(fit dl f� 4-/Q t YI.O O ,cA" <br /> ! <br /> CONTRACTOR NAME: Asp c I S1 RE LL C CJ / <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): A VIJ <br /> j J LL `�L.Q� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6,584.V V <br /> PRIMARY CONTACT: yKOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:A ` vx\Asotry ,k CONTACT PHONE:29 t13 <br /> 06 c4 b 9 <br /> CONTACT EMAIL: (mot (3viJ ya�telec ,e.tiri <br /> BUILDING PERMIT APPLICATION I !Y `t - 4,5-?c.$i <br /> Existing Use of Building: S F R 4 \\ Contract Price of Work:$ 1. , :ti` <br /> Proposed Use of Building: s F f\'F{l Heat Source: " Gas ❑Electric ❑Other <br /> Building Type: XfSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition XRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: by\ea_ ce, .0-10_' m ork � <br /> S V n 0,4 4-0 QCc_9 okcAfy. k 0. s etiorof <br /> nQ re.pi-bo Ur n <br /> w P d � a MetAi <br /> Weal Lt./ �'"Yt S 12a_�- �v, syr"►� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> y / <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 #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures 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 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 I 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 from the <br /> Building 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 /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> • <br /> PERMIT <br /> 1 �� �- 565 —02.7-, <br /> .0)----'-/Authorized Agent Signature Date (Revised 9/23/2016) <br />