Laserfiche WebLink
477- PERMIT APPLICATION■ <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 Buck Ink Only Please) PROJECT SITE INFORMATION.,' <br /> PROJECT SITE ADDRESS: 41(Q Ct; - ` PROPERTY TAX#: 1 cog 7 coo 06c/ v O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ff CC.. t;)` L... .. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET LI/(v Ci &. p 2 <br /> CITY EIfQCC- �^ STATE f� �(` ZIP C t Zd <br /> OWNER PHONE: 4/2_5 3 73 7 OWNER EMAIL: <br /> CONTRACTOR NAME: Com'�p k (A)% ,,k/. <br /> C C rtiF -4< SfAAJ .t. "—C <br /> CONTRACTOR ADDRES • sTReErt-F-t{fiaQ (S— G�ry.�c w0.y t <br /> CITY AIA eSTATE W <br /> CONTRACTOR PHONE: L/w2S-S'O t.-6 t3 a CONTRACTORu EMAIL: j (_c - 64ov.e_ct4u4L <br /> CONTRACTOR LICENSE#(REQUIRED) 5 OAJj W4S5(D/V CITY OF EVERETT BUSINESS LICENSE#(RE UIRED)' 0 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR POTHER(Please Specify) <br /> CONTACT NAME: `\ CONTACT PHONE: L'2S 5 g'3 - 229 £5' <br /> W�6W'Z S'� 11f-C\ CONTACT EMAIL: c..3 S wt; & & ,vk/r(• C <br /> l <br /> BUILDING PERMIT APPLICATION ,ems <br /> Existing Use of Building: ,S" I+z F� /rc7 Contract Price of Work:$ eej Ben <br /> Proposed Use of Building: 12A".o� S[n ({ & A_ Heat Source: El Gas kiklectric ❑Other <br /> Building Type: , SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial El Industrial <br /> Type of Project: El New ❑Addition ,Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> es.,..) „JP„J0 �d?n- n'_QJ ��.cS i CGA,, i � Ca ,. re/ <br /> S, <br /> u pb <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 /> #ofList 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 4 Z Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater / Bathtub Urinal <br /> Gas Piping Boiler 2 Lavatory(Wash Basin) Drinking Fountain <br /> ( Water Heater Refrigeration ( Shower Floor Drain <br /> Gas Fireplace Wood Stove I 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 /> 1. Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> :„___, SPRINKLER/;SUPPRESSION SYSTEMr ,_,, <br /> Number 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.lam 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 /> 1 2_ <br /> ner/ horized Agent Signature ate (Revised 5/20/2016) <br />