Laserfiche WebLink
PERMIT APPLICATIOI= <br /> 01111111.1,0-4 <br /> BUILDING 1 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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: b2.J4• )• •CI`nO I• PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (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: �-7- ) OWNER EMAIL:., � , <br /> 4 CONTRACTOR NAME: S ' -lkl4'V C/�SA (Zzjg(� 31 lie-- <br /> CONTRACTOR ADDRESS: STREET ZZ5 ;f-Ati- !d v` ,t A ,•f <br /> �•_)CITY $ i r t STATE ( \ ZIP / ii o., <br /> CONTRACTOR PHONE: Z1:( ' fr,�%J �g CONTRACTOR EMAIL: NcICJ �(I tits C 6 fie( <br /> CONTRACTOR LICENSE REQ_UIIRED): ``�� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION ff <br /> Existing Use of Building: Contract Price of Work:$ 31-10b1°. <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> pe of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> D SCRIPTION OF WORK: ^ cm 't'i 01, 0 <br /> VC01 44/70( 2F-Pitic Lei&it <br /> .... <br /> w- 64(1-40144C A- Vol( k. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): $�nD2-t)•9j <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 #°f List of Fixtures #°f 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 /> 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:1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> curl-.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 /> Bu ldin• 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 StaidContractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /��Ir i PERMIT V \--70 ( -O2 <br /> .., <br /> Own r/Au •rizedA•entSi.nature Date ?Revised 9/23/2016) - <br />