Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING!SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' 7 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 et Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I 1 E 1'Ne-Ye/+Pi q 1/ Wel , I d r f. t PROPERTY TAX#: 00145 0 20/ oo5O2 <br /> LEGAL for new construction: Short Plat/subdivision Lot�o. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: K.6‘01.6„. 1 n V 0rj1-m, e c~of TENANT NAME(If Commercial): &/ivy it e r 5-,,I long 4, <br /> OWNER MAILING ADDRESS: STREET .10 (v 55 ALE Y's17 St 51e, clo ' <br /> cm( 45t�1��Vt�f P_ . STA E `1/ ZIP7e j 00 C� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ill a /'-eheni / > r J <br /> CONTRACTOR ADDRESS: STREET ZD I. n -L 1 .J ci- <br /> CITY a. W}i'_Q STATE ZIP CE$(2c <br /> CONTRACTOR PHONE:LZ,5 no SQ-fff4��'�����11 QQ +CONTRACTOR EMAIL: a— e._ tr 1�• ,nJ ( <br /> CONTRACTOR LICENSE#(REQUIRED):'I� �pW i4O 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ag <br /> PRIMARY CONTACT: 0 OWNER ❑[CONTRACTOR ,OTHER(Please Specify) rGlr11 ff'G f <br /> CONTACT NAME: Z /- /P 1/� 1- >iAlit jr' CONTACT PHONE:(lyc) Z5 2 - �I� ?� <br /> 2t1/0, 44 ird t/' ' 1z r e, CONTACT EMAIL:dip2/aOg mjzay.el-,,'/es' re,eeivl <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: /51- .T.-/e-05 Contract Price of Work:$ •Gtr ®®0 <br /> Proposed Use of Building: t✓,f... •Iv/e '5 Heat Source: 1Gas DElectric DOther <br /> Building Type: DSFR-Detached DSFR-Attached DDuplex DMulti-Family-#of Units: $Commercial 0 Industrial <br /> Type of Project: ONew DAddition DRemodel DRepair *T.l. DSign DSprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK:, 3, /,l' 30 , , <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 /> 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 ' 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 /> ��I <br /> J City of Everett Official Use Only <br /> /.0464411tf . 74f �" Pus ..._ 03s <br /> Owner/Authorized Agent Signatur Date (Revised 9/23/2016) .r <br /> r <br /> f. <br />