Laserfiche WebLink
PERMIT APPLICATION <br /> Alf.frBUILDINGI/MECHANICAL I PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> AV� 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 <br /> INFORMATION <br /> X•PROJECT SITE ADDRESS: 0 9,c)c) 6-3,-,A. j - J PROPERTY TAX#:00 L1 37.47,5724 02? CN, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> X OWNER NAME: SA-e_,1/40..._ ( TENANT NA E(If Commercial): <br /> OWNER MAILING ADDRESS: STREET L-( oc k fL.cw <br /> CITY M 0 44 t 6 .CAl 1\S STATE 21P�. <br /> OWNER PHONE: /. /1s- 7) 3 �� OWNER EMAIL: VVV""" ��J 4i <br /> X CONTRACTOR NAME: p�( ) / v ` <br /> CONTRACTOR ADDRESS: STREET <br /> - - ,� T <br /> CITY Si <br /> =� - �— <br /> CONTRACTOR PHONE: a Jnr CONTRACTOR EMAIL: - , <br /> 1'CONTRACTOR LICENSE#(REQUIRED): TY CIOF EVERETT BUSINESS LICENSE#(QUIRED) ` <br /> PRIMARY CONTACT: Ll'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (4-z5\ ' -P--Ta ZA- t $ <br /> S+-ere_ r CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: _ Contract Price of Wor .$' 14 sty <br /> Proposed Use of Building: - _�Heat Source: El Gas DElectric ther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex L+'IMulti-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel BRepair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:Re. k,„ R42... \\Q___Q--'s <br /> gv Cz-p aciz °C) .-') <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 1 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 properly to perform the work for which application is made, <br /> and I comply "h the State Cont ctors Law 1: -0W and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � ` � Pite -30- 02 IT# <br /> Q,..,(4 ...... 0s(, <br /> •wner/•uthorized Agent Signature Date (Revise 9/23 <br />