Laserfiche WebLink
Wjlign. PERMIT APPLICATIC <br /> BUILDI�IU/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 Black:Ink'Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRES. 552g' "BY) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .(/ //^�. / F(f-z „-G i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 g// — /c2/11.70/_5_55 ��� <br /> CITY /../6 ,• STATE e„,/.1&/ ZIP g`9 8 <br /> OWNER PHONE:La CC - ago -7577 7 OWNER EMAIL: <br /> CONTRACTOR NAME: f4-(/ 4r,7— /�p4?G PG 7`e <br /> CONTRACTOR ADDRESS: STREET ,2 3..2... 3 /62,h , , E <br /> ._ <br /> cm, fa,,yI r!"r -e.sG 0.3 STATE (' '•�/ ZIP q_t 2 '7- <br /> g-- <br /> CONTRACTOR PHONE: V_,0(-_2,e-fa 75 O7 CONTRACTOR EMAIL: AA C L L�. 1-0e' e ,4_, ( G t9'-'^ <br /> CONTRACTOR LICENSE#(REQUIRED):/r G G,ql3A G gS 7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OSy 7/e( <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L/,2 55"-- //77,2- 06"ge-/ <br /> CONTACT EMAIL: , DCC-x ,`,,,;Ca ��G1*14 Ti. GO'^^ <br /> BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ \b,b&O•°" <br /> Proposed Use of Building: R. Heat Source: ❑Gas s Electric DOther <br /> Building Type: 1t1SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 'New Addn _Alteration _Repair Type of Project: X_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 3 Toilet Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> ' Range Hood Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I 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.1 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 Contr ctors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# 3 ci o l -oz�)/ <br /> /....:ida.L.:4_2 -) <br /> Ow !Muth rized Ag: t�: .• re Date (Revised 9/23/2016) <br /> ii"- Vim, <br />