Laserfiche WebLink
PERMIT APPLICAT <br /> BUILI il/ MECHANICAL/ PLUMBING /SI ell- PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ///'5 G/?,4-4'n '4 jr(v 57-or PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: / J ) . //.lQ TENANT NAME(If Commercial): / ,q f <br /> f/i <br /> OWNER MAILING ADDRESS: STREET R _ `1/ '/ /)U :: <br /> OWNER PHONE: G, S it OWNER EMAIL-: - • AWAY 10 I <br /> CONTRACTOR NAME: `Dliy COZG/�5 /J <br /> CONTRACTOR ADDRESS: STREET C/ 3 2 all 57: 5w S '-7 7 i� `� 5q�� / <br /> CITooN rG / i Tem)ALG-�i STATE "W A ZIP 7? 4 <br /> CONTRACTOR PHONE: e! 3Gf` CONTRACTOR EMAIL: CoG1._ S l0 MJF O 1 & 6444.4.z, (-0/1/) <br /> 6 <br /> CONTRACTOR LICENSE#(REQUIRED):C C .0k.TE C 4702 C lQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): J ?3 3 6 <br /> PRIMARY CONTACT. $CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: z ?j•- -f SZ <br /> 1.-0e/ r; <br /> .0e' F CO6 L 4-5 CONTACT EMAIL: C6644_5 L O"2 F a• 1/ e 4.4,11- .0041 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ f 0/ ,c0 U <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DT.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: F FYSS r'x/v6 foe F- CS/-i4)(. I SN4 1'htL 3A3 ! /0(0 we" <br /> 2,v574-Li- 1//1/013-X L4-wviE/vr Roo F u•ufil1 L4-M,I:iv,4-Ti5D r-r ?GLit S5 '/ NoL4"S <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 _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems 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 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 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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> .° • PERT; 80 <br /> 6--024 <br /> Own r/Autho ed Agent Signature Date (Revised 9/23/2016) <br />