Laserfiche WebLink
PERMIT APPLICATION <br /> 011111 BUILDING / MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> it B <br /> (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> e O : I.. ,, , P ; 1Ase 3,v_ Sok``i, PROD *�f t/,y •R� i, ,' rtci 4�1 F <br /> ,f ■# eaY�.ui..w , <br /> PROJECT SITE ADDRESS: �� a 41 +" DY- q la PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)■fCi( <br /> OWNER NAME: /11 E/ I) ,, `` jTFNANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET OIDD7 'TLf-(� f"' Ave./ R <br /> CITY L7i,Jujo`` ) STATE ZIP (1. (3ic <br /> OWNER PHONE: 2321 <br /> �� 7�D7 OWNER EMAIL /�J �/'rjf�1P,�3(> ,op ��I <br /> CONTRACTOR NAME: 4rake i�'"� t4 Ake i2 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t\-Rc-- <br /> PRIMARY CONTACT: X OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: bawl_ iv‘ro�. _M /J CONTACT PHONE: 426 232 071(/ x /j� <br /> G,v CONTACT EMAIL: u) i t/in/S- ,f U e..D .C) <br /> Existing Use of Building: Contract Price of Work:$ /f/ 0.-------- <br /> Proposed <br /> lProposed Use of Building: �) Heat Source: ❑Gas ❑Ele ■Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel i 1Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition )(Change of Use <br /> DESCRIPTION OF WORK: <br /> a-!�IL °IAT -12— <br /> A OCIATED BUILDING PER , #(if app Ica e : �� t�f SA Le S - <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteratio _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-Air Hans 'ng Units Heat Pump Toilet ackflow Preventer(Inside Bldg) <br /> Forced Air Syste'„s 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 Hook,.is Other: Clothes Washer Medical Gas <br /> Range Hood I Water Heater Oth r: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Ot er: <br /> iN.:,, UI Pit ION 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 th State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE <br /> # <br /> " :la- . ISS -- <br /> Owner/Authorized <br /> fY Date (Revised 9/23/2016) �� <br />