Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING I IJLCHANICAL/ PLUMBING /SIGN /UH INKLER/ DEMOLITION <br /> 4414/%f----4 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 44 50 to C a\6y R U E PROPERTY TAX#: Q Q q o-] C)O 1 O OQ 1 02_ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> a <br /> CONTACT INFORMATION <br /> OWNER NAME: Thn i t b'J N N TENANT NAME(If Commercial): [I 0 <br /> OWNER MAILING ADDRESS: STREET 9 5 0(o Co 1 131 9 vE <br /> CITY Ev ese fi-- STATE P ZIP 9 B2.63 <br /> OWNER PHONE: 7 Z S" 3 y S - Z.7 I ! OWNER EMAIL: `-2__J O1-111 i e LI 7@ Q O I I ''corn <br /> CONTRACTOR NAME: '31,\-1(-)j e 11 vi r-i a.tJ <br /> CONTRACTOR ADDRESS: STREET /3 m e. LI S CA0 Cp 0$y qJ <br /> CITY Cu 2T>°kt STATE (.13 a ZIP ,8 Z 03 <br /> CONTRACTOR PHONE: -f ZS . 3LI3-271 cf CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): N f <br /> PRIMARY CONTACT: ROWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existin• Use of Buildin•:Sc -1r Ci,Aa F 7 / 5h0. S+oc t -) . Contract Price of Wor .$ a5OO f OQ <br /> Proposed Use of Building: 'new G flC Ce_ / 51noF Heat Source: ❑Gas` ❑Electric ❑Other <br /> ® <br /> Building Type: SFR-Detached USF -Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial [Industrial <br /> Type of Project: ®New 1:.7Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: '- <br /> /�IEu1 Gq+�'q� <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 _Add _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures of List of Fixtures <br /> Fixtures Fixtures Fixtures ixtures <br /> /VO NC-Air Handling Units o He ump Toilet > Backflow Preventer(Inside Bldg) <br /> N O Forced Air Syms 0 it Heater 0 Bathtub (.) Urinal <br /> /0 0 Gas Piping 0 Boiler o Lavatory(Wash n) C) Drinking Fountain <br /> (J C' Water Heater Refrigeration O Shower 0 Floor Drain <br /> N)0 Gas Fireplace r Wood Stove 0 Kitchen Sink ispos I 0 Grease Trap <br /> n7 G Gas Range © Ducting Dishwasher 41 Roof Drains <br /> tom) '0 Clothes Dryer Hoo s Other: 0 Clothes Washer 0 Medical Gas <br /> /`9 Li Range Hood © Water Heater Other: <br /> N v Exhaust Fan O Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 'Number 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 limply wi --State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ,, / City of Everett Official Use Only ,; . <br /> 1;VIITc#4.03 ,.._0 in V <br /> yz., <br /> ,...� <br /> Own- /�ut •. -gent Signature Date (Revised 5/20/2016) <br />