Laserfiche WebLink
PERMIT APPLICATION <br /> "1111P.44 ----4 BUILDING/MECHANICAL I PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)L PROJECT, tSITE INFORMATION <br /> PROJECT SITE ADDRESS:931 C p 1 t kVL '444.1 Yt 0112.5\ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivisionQ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ( 114.L Alton TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET a31 (p 414. ikot(. <br /> CRY Eu(X1 STATE lij <br /> ZIP _(i 201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: kill.t i)1 Ut is q <br /> CONTRACTOR ADDRESS: (J siREET Q el t2 J.:43bi ¶k- t "' t'1cnY 1t`tlMonJ STATE ZIP 6k \Q <br /> 47,4 <br /> CONTRACTOR PHONE: 42S• '&6S- 14/3 CONTRACTOR EMAIL: )I •b 1 1,0(,Ks <br /> ps$VA1�Na. C b <br /> CONTRACTOR LICENSE#(REQUIRED): 2, J G Q L.Nan_ ,S CITY OF EVERETT BUSINESS LICE,_NSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER pi CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM <br /> : (''(� CONTACT PHONE: ZS' 65,. i 95 <br /> 1 \�A Pt V �1A l V 0.61,„.t 6 W„IG4) CONTACT EMAIL: %ilk a kz `V a .b: t . c, <br /> BUILDING PERMIT APPLICATION "` <br /> Existing Use of Building: Contract Price of Work:$ I )I)0,°� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition IXRemodel ❑Repair ❑ 1. ❑Sign ❑Sprinkler ❑Demolition OChange of Use / <br /> DESCRIPTION OF WORK: 1.10 <br /> � 4*1 l hS)l{1.i,tfrn Z S h oW y^ ye L SIC f <br /> ,.o <br /> a , .-y►?e .., 7" /,,,p 4, �fta� Ste'/ p <br /> 4 el <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 ,__Addn ZAlteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> o NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> 0 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 0 Water Heater Refrigeration 1.., 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 INo.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.lam the owner,or!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 298.200A WAC. <br /> City of Everett Official Use Only <br /> �PER/ MI1 6 5.-- <br /> / bob I <br /> is <br />