Laserfiche WebLink
PERMIT APPLHCATIOI <br /> BUILDING/ 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: ) /3 Cl 4 F ST 1J U 1- S T- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i 77E� rt )e2&c--.77 — TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET c91. <br /> CITY �U�^�.���-- STATE. 74 ZIP 9S-g.0 <br /> OWNER PHONE:(q .���a OWNER EMAIL: 1.4t 7.t2 V1 bu�eLr� �vv�at�l . C10 <br /> CONTRACTOR NAME: CDLL7 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 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 APPLICATIO ~ <br /> Existing Use of Building: Contract Price of Wo :$ bei <br /> Proposed Use of Building: Heat Source: ❑Gas <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 0Multi-Family4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 4<uv.5 G,qS P1 PI/06 uP 7-a —wa A)E2.—) YV1€7 _ AA7 PPpu �c—� L src� <br /> l EL3Dc.g <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 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> fC 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 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 lam 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 /> •• <br /> PE "# tg . 022' <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />