Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 1 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (BIUe,sor'Black Irlwo*::p easel° , PROJECT SITE INFORMA'T=IoiN . : , A; <br /> PROJECT SITE ADDRESS: ci.20 t,A, 13v-oaotWGto& PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ,..: CONTACT INFORMATION , <br /> OWNER NAME: (1,6m v\t ( -ea-W1/4. e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET %CA f yc'e l W <br /> CITY `C,�Xetil _Q STATE \Ai.14 • ZIP a5‘240g <br /> OWNER PHONE: -*DS—7 gel--3--too OWNER EMAIL: 1E2 `V( @ „,lnncs 1o$,0)9c <br /> ,tel.... <br /> CONTRACTOR NAME: daY1 SN t k CA i-v.e S <br /> CONTRACTOR ADDRESS: STREET t%.11 ( 14.pw: AW. VJ "(kA-1--t- 3 . <br /> CITY MO000!) STATE \/UIA-, ZIP awv <br /> CONTRACTOR PHONE: 4.--. 5- q(Q1 CONTRACTOR EMAIL: 'yW,W eX1'e Gl e)rottm,WdA-,dam <br /> CONTRACTOR LICENSE#(REQUIRED):(11 3J j`1.02.N.F CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O25a <br /> PRIMARY CONTACT: 0 OWNER igtCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAMF: CONTACT PHONE: 4E5_ 4(¢`1- O <br /> al ,ej--Vonsoa t\-- CONTACT EMAIL: rnwricesoce gC11s 0u)ZeAOies co in <br /> BUILDING;PERMITAPPLICATIoN <br /> Existing Use of Building: W\-Cot(NQ• (-J yt,((v, Contract Price of Work:$ $1 0, 600 <br /> Proposed Use of Building: h0 em a(i „ Heat Source: OGas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: Commercial CI Industrial <br /> Type of Project: CI New ❑Addition CI Remodel ❑Repair NIT.I. CI Sign ❑Sprinkler ❑Demolition ,:;hange of Use <br /> DESCRIPTION OF WORK: 1/4,aaC E ,e_X*SM O Nr �� 5 o'i- ,-u r ,r, , av\a at A 0 <br /> Z&vles I,ibeAe -On\\ 4CipkiticUrl <br /> ASSOCIATED BUILDING PERMIT#(if applicable): t /A <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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ': <br /> SPRINKLER I;.SUPPRESSIO SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this ,pplication 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 gran ng 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 und, any circumstance.lam 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,8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ` rr,n, + PERMIT# r >� <br /> �1,�e , I oTali/? n 06.1.,Owner/Au orized Agent Signature Date (Revised 9/23/2016) <br />