Laserfiche WebLink
I PERMIT APPLICATION <br /> '111IP/A ---- '.-4 BUILDING J MECHANICAL/PLUMBING/SIGN / lit <br /> /DEMOLITION <br /> 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7L/b Cl[ ,eakiY,zys,y,, J,7 c'u,�.f„- A PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 7 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: c� J TENANT NAME(If Commercial): r�f,, C/�� r <br /> OWNER MAILING ADDRESS: STREET 1? )< 1 � C)v Sm(" <br /> CITY �t I (i/cP-e(c 1 STATE - ZIP cA ® j <br /> OWNER PHONE: 42 - 4,6 - yy Z OWNER EMAIL: <br /> CONTRACTOR NAME: S c <br /> CONTRACTOR ADDRESS: STREET //9 }� `7 to <br /> /q tti �' g4 <br /> CITY 7, Lai STATE WA-- ZIP ye„,_?‘ <br /> CONTRACTOR <br /> PHONE: /r ,5-,�ap o ,/..._ CONTRACTOR EMAIL:jauc a c t-11 - S .(div-. <br /> CONTRACTOR LICENSE#(REQUIRED): _p5 . .9h5---T ) CITY OF EVERETT BUSINESS LICENSE#(R : .5 EQUIRED): Q� ;�.0 <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 42c- _27.3..-a u c:7 2 <br /> ��f�vt- $ PO CONTACT EMAIL: 1 �s- / —��1...5- t Blit-, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ' 'O P 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 0 Multi-F9mily4 of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair DT.I. Ugign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> • "‘-(4-0i <br /> ��� <br /> '`� (f Cl/Y,0Ike ( <br /> 1_,_, ,,-40.--s an keCe b,il <br /> ASSOCIATED BUILDING PERMIT#ilf 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 I 1No.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 298.200A WAC. <br /> City of Everett Official Use Only <br /> 1C_ D-- -- / ----2-V -—i 9 PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 9/23/27i.2 ` ') <br />