Laserfiche WebLink
4. PERMIT APPLICATION <br /> BUILDINECHANICAL/PLUMBING /SIGN / UWINKLER/ 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 wwweverettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2-739 12-7-11 <br /> PROPERTY TAX#: Z 9O S'17O0 /03 20V <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: EVL`' 1 f\-OVA^) 0 L 14 , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3(6-7 CQ[ is cz. <br /> my -__,) e_e Tr STATE \/,r — ZIP 9 5 20 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: -1' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER D CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (...F2:75-- '2„Q"3 1 rr (51.ILy <br /> .?si-r;_05 k .-,.4-)1. CONTACT EMAIL: ,f-7iy,f-cf k Q e__,, 1�1,,„. , (5,✓^q . <br /> 1 <br /> BUILDING PERMIT APPLICATION \,J <br /> Existing Use of Building: "'Y t}-r-'- 1 s Contract Price of Work:$ ID <br /> Proposed Use of Building: SPr-co€ Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: USFR-Detached USFR-Attached DDuplex C Multi-Family-#of Units: q DCommercial ❑Industrial <br /> Type of Project: DNew DAddition GRemodel DRepair CIT.!. DSign DSprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): —0 17c 3 0 S91) <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 /> NC—Air Handling Units Heat Pump 4 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 9 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 /> t� Range Hood Water Heater Other: <br /> f;' 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 l am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAG <br /> City of Everett Official Use Only <br /> ...-..\e_ �- r-- PERMIT# <br /> � 3- 1 ' _ R-lo& - Det <br /> 7''''.\\ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> I <br />