Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> '91P0467/::a 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 h k my Please] PRO�fi SITE INFORM ATION " <br /> T <br /> PROJECT SITE ADDRESS: er Ibi 0. 020 l L.0?.... '‘"— PROPERTY TAX#: /)?qG( 0001 ) lOO <br /> LEGAL for new construction: Short Plat/subdivision,&.(D(Xt(1)41 �. Lot No. I (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: / Ci-At/7a 4i11,114 <i-s J 1 ,Ai., id TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 11 SO Ay io t i4 A v u <br /> 511.(dU-it,‘" CITY /O%64.1 Ai // STAATE C414.. .17ZIP V( 3 <br /> 0206- OWNER EMAIL: Co ivA9C/'-( )9rn,c�al�,�j<S it/L` ' <br /> CONTRACTOR NAME: 4/l 6 rjQ,,,A 7-i. c .7-.7,,C <br /> CONTRACTOR ADDRESS: STREET /7 To (" /41,1€e OA 4 (/ /4 <br /> CITY 5 Po it 61.s...6" STATE Cc/4 ZIP /q?i 7? �[ <br /> CONTRACTOR PHONE: 0C- p/-'7G 7 7 CONTRACTOR EMAIL: Oo%./tAC f'o'- ill4C.(Ittiop2K/7 e-5.14It/ <br /> CONTRACTOR LICENSE#(REQUIRED) AO}1C pie pi g CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: CIOWNER 1l CONTRACTOR ©OTHER(Please Specify) \ i <br /> -' )-44,?e' <br /> CONTACT NAME: / CONTACT PHONE: (� ( l G 7� . _ In- <br /> n- <br /> Ae,2484, /7/144¢ b, CONTACT EMAIL:cs�j4�C ' /! 4Ip/Pop�e f'j°�/es- Av6 <br /> BUILDING PERMIT APPLICATION ' <br /> 9(9 <br /> ; + CEJ (�_ c9 ..+ ,. <br /> Existing Use of Building: Contract Price of Work:$ / ' b <br /> Proposed Use of Building: /Z,— 3 Heat Source: WGas 0Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ew ['Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ['Demolition OChange of Use <br /> DESCRIPTIO OF WORK: <br /> ' (-1° rev CT?CAI o`F '- ria(Ncu7— —F 41-4 IL-1 S t pZAJC <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION " PLUMBING PERMIT APPLICATION <br /> Type of Project:)New _ Addn _Alteration _Repair Type of Project: XNew Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> / Forced Air Systems Unit Heater / Bathtub Urinal <br /> Gas Piping Boiler -4- Lavatory(Wash Basin) Drinking Fountain <br /> 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 /> 5 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.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 /> )V.4.6 ...... ,..,i 'Th <br /> Owner/Authorized Agent Signature Date (Revise 9/23/2016) j' ✓ <br /> k/ lk <br /> ,/� <br />