Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING / MECHANICAL ! PLUMBING /SIGN ! SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMlT 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 /> ,(B�ue or Black Ink Qnt Ptera�e} PROJECT StTE tNFORMATION <br /> PROJECT SITE ADDRESS: /2,2 /f g'�'�C}��',S� �;;{j�-�..�� ��� pROPERTY TAX#: �„�`Y' �'F/��r��� <br /> ;LEGAL for new conslructio�: Short PlaUsubdivision Lol No. (ariach copy of long legal description) <br /> CONTACT iNFO�MATION <br /> OWNER NAME: �j�(,,� �"�'fj,l� TENANT NAME(!f Commercial): <br /> OWNER MAILING ADDRESS: sTReer �j�jt�j� �- <br /> �n_� <br /> s rarE zia <br /> OWNER PHONE: �;LS �� - (�`7 D OWNER EMAIL: /��CNieISTE/Yd�l/� �UL-L'dyy� <br /> CONTRACTOR NAME t,,�i,�+,Qj� � +�'"j"�f�/,�'" �j��'jN�, 1 NC. <br /> CONTRACTOR ADDRESS: �rHteT j7'�jr„'�y /�'�'� �,,y i,�� �+� ,� ��� <br /> cirv �T" ,LL wi4- <br /> ,�.,�: ��F 9��� <br /> CONTRACTOR PHONE: .',�,�,-'--. <�tT- CQIV'fRACT47R.EMAIL: *-tS�F �+C7RN /�l�flNf,.�.CUi� <br /> �ONTRACTOR UCENSE#tREQUIRED). �Q�Q/�/��(j)11�.� CITy OF EVERETT BUSINESS UCENSE#(i2Et]UIi2ED): D.3�"� <br /> 'RIMARY CONTACT: ❑pWNER C�'G�ONTRACTOR ❑07HER(Please Specify)�_ _ �_� <br /> ..__ <br /> �ONTACT NAME: GC3b1TACT PHONE: ,e���yr-_.S/8,5-����� <br /> K rts�- ��-; ���w�..��n�v �'Uy�����'� CONTACT EMAIL:Kr't'� /'°��j��l�ST�QGI�F'aPN�^.��/'y� <br /> BUILD#NG PERMIT APPLICAT'tON <br /> =xistin Use of B�il�lin j� ` Contract Price of Work: � �-0 g � 60 <br /> �rra c�sed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> 3ui{din T�pe; SFR-Detached ❑SFR-Attached ❑Quplex ❑Multi-Famd -�t of Units ❑Commercial �Industrial <br /> � p�of Project ❑New ❑Addition ❑Remodel ❑R ❑TJ. (�S€ n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> ?ESGRiPTiON OF WORK: <br /> !�'n 6U�- C'ed.�tii ����c,S - lr�-a..� �Gy�or� � ...s",G�-�,.��.�� <br /> �SSOCIATED BUILDING PERMIT# ff a licabie : <br /> MECNI4NlCAL PER�IT APPUCATION PWIY�BiNG PE�NliT ApP't.lCA"1`1CNt <br /> ype of Project: _New _ Addn Alteratfon _Repair 7ype of Project: New Addn Alteratlon Repair <br /> #of — — — — <br /> =ixiures ��st of Ffxtures #�f Llst of Flxtures #°f List of Fixtures #°f List of Ffxtures <br /> FJxtuies Fixtures Fixtures <br /> A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer lnside 8!d � <br /> Forced Air Systems Unit Heater 8athtub ��j�g� <br /> Gas Pipin Boiler Lavatory(Wash Basin) [�rinkin Fountain <br /> Water Heater Refri eration 'Shower <br /> Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink$Disposal Grease Trap <br /> Gas Range Ductin Dishwasher ��{���r�� <br /> Clothes Dryer Hooku s Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBarlMo letc. Dther: <br /> SPRINKLER!SUPPRESSiON SY8TEM <br /> P(umF.�er of Heads <br /> :KNOWLEDGEMENT:I have reviewad lhis appNcation and con/imt!he inlormation contained heroin is lrue and correci. Work done pursuanf to lhis pe�mif must comply with <br /> �r�ent federal,s�ate,and local law The gran�ing of a permil only aurhonzes approved work and no deviations therelrom.Devrations must first be aufhorized m writing/iom the <br /> �ilding OKicial be/ore baing aufhonZed under any circumstance !am!he owner.or 1 am authorized by the owner of 7his property�o perform the work lor whicti applicalion is made. <br /> �d 1 compty wrth fhe Sfale Contractors Law 18 2T RCW and 296 200A WAC. <br /> C�ty ol Evere[t O�cial Use prsly <br /> �/7�i.�t.� � PERM � V � O 1� <br /> hner Authorized Agent Slgnature Date ��„�v��g����j��yi�� <br />