Laserfiche WebLink
3 <br /> PERMIT APPLICATIO- <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 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 /> � <br /> PROJECT SITE ADDRESS: "l t. l.(��.5'vIo - 6' )t PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision LoMJo. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: g `IR tiA } l/ C� ( V L-LC- <br /> CONTRACTOR ADDRESS: STREET 223 ,,-m- Avg A <br /> / ,1r <br /> CITY '‘ 'P STATE (Aif ZIP ?i;�tri <br /> CONTRACTOR PHONE: Z' ' r!%I 469 CONTRACTOR EMAIL: ('t`C j 1 fin�f,S € ( r) <br /> CONTRACTOR LICENSE REQtqrUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> • <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ "b900 , O� <br /> Proposed Use of Building: Heat Source: OGas DElectric El Other <br /> uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial <br /> pe of Project: ❑New ❑Addition ❑Remodel El Repair DTA. OSign ❑Sprinklleer�` ❑DDDeN-Y) <br /> molitiion ❑Change of Use <br /> x D SCRIPTION OF WORK: +,'_��// /� CA <br /> i _ l� Cif/lc-ES <br /> VEL ��j7' ,".,µ— t?/ 3/ ( i f C <br /> 1)x- twat g <br /> A- n <br /> ASSOCIATED BUILDING PERMIT#(if applicable): `$not-02,7.1 <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 #of List of Fixtures #of 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 /> 7 Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' 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 /> cum-.t 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 /> B Idin• Official before bei •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 /> a .I co 'ply with the Sta-i Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P �� PERMITS t�0Le-'0 15 <br /> FVC, ����! <br /> Own r/Au .rized A.ent S !nature Date (Revised 9/23/2016) / <br />