Laserfiche WebLink
PE MIT APPLICATI <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> Irk CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: t 2215" ( 6.A5i 6.0 12.4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ,.,i 6 rr r OLi t No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: R P le- A`01(e Cie 1e4 — aC., TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> crrY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: be Bv..., C tuvvv`J 0 evo3 <br /> CONTRACTOR ADDRESS: STREET of( 5 )G(x ff-c( 51' <br /> CITY kc.0�A._ STATE W IA- ZIP 4961. <br /> �t 0 CONTRACTOR EMAIL: <br /> CONTRACTOR PHONE: ©G ?(/ - 2040 6 (/t(G%n h F..AGCOt^ PjU ' �3 , c,,• <br /> CONTRACTOR LICENSE#(REQUIRED): �t A-C-O 9 q s-6 K S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):!©y�3,f 91 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR LI-OTHER(Please Specify) ) 6J t o(,✓/Akk pi 60 f <br /> CONTACT NAME: CONTACT PHONE: 20 6_ gig ..— 9/o( <br /> bAU (or VAr-1--L CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ci_4 g& -00 <br /> Proposed Use of Building: pal 13,s4.(^ Heat Source: OGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial Dlndustrial <br /> Type of Project: ❑New ❑Addition 7Nmodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> MA I COCA,44 cc 4- INC( t (.---(04 Jct L <br /> L U. t LAv $� i4� <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump I 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 /> I Q1-2 --( ) Pr <br /> g <br /> •,n •jthe.Agent " Date (Revised9/23/2016) <br />