Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> 401104, CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 U )II4ertjettopeCorlitreftwe.gov i www.everettwa.gov/permits <br /> Slue or Black Ink Only Plea�ti PROJE 'T i N RM4 N: � <br /> PROJECT SITE ADDRESS: I 35 4. Lpol,,tc?4a,.rct JPROPERTY TAX#: <br /> LEGAL for new construction: Short Piat#sttbdi4;on Let No. (attach copy of long legal description) <br /> CONTACT i it iR IA' ION ; <br /> OWNER NAME: TENANT NAME(if;CommeCCtal, A; <br /> OWNER MAILING ADDRESS: smear I e)r tto <br /> CtT'Y <br /> NER PHONE 425 2 2 !-f <br /> I OWNER EMAIL <br /> CONTRACTOR NAME; C - Inc_ <br /> CONTRACTOR ADDRESS: STREET � oa <br /> STATE A ., _ ZIP <br /> CONTRACTOR PHONE: <br /> 5 ,CONTRACTOR1tAIL <br /> - testa 4tiRe =' cOPEVERVITSIMINESS IREDY 060/ <br /> S <br /> PRIMARY CONTACT: ❑OWNER Ct tiTRAGTI R' 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE 42,6 _255 <br /> CONTACT EMAIL L '� ``! ,.. ° [p <br /> rvi <br /> Elitsttrt Use of Building; Contract Price of Work:=S �a <br /> Preposed Use of Buildi`irg Heat Source: Ails ❑Electric ❑Other <br /> Stt{Id,iTS FR-Petechud DSFR-Attached t Dttptext ❑!VI Ittl-Famlty4of Units: 0Commercial ['Industrial <br /> Type:of Project. ❑New ❑Addition ❑Remodel 1:IRepaI' ❑T.I, °Sign` ['Sprinkler ['Demolition ['Change.of Use <br /> C3�GRtFs't'tnN`OF WORK: - _ <br /> Re pla.ca, gas <br /> ASSOCIATED„BUILDING PERMIT#(If awpllaable): <br /> I1;APPL1CATION : g t <br /> z <br /> PMI A <br /> A1+ '1'I19�t� <br /> -Type of Project _New Addn ,Alteration _Repair Typo of Project _New Addn Alteration _Repair <br /> #of List - #of <br /> A/C-Air Handling Units HQ t Pump rToilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping :BOO ;Lavatory(WashBastnDrinking Fountain <br /> Water Heater Refrtgeratioti Shower <br /> door Dralri <br /> Gas Fireplace earl Stove Kitchen Sink&Disposal 'Greate'Trap <br /> ; <br /> Gas Range <br /> uuotIng ,Dishwasher Roof Drains <br /> =Clothes Dryer Hookups O Clothes Washer Medical Gas <br /> Range Hood <br /> Water Heater Clther. <br /> �Exhaast Fan Sink Service/Barr/Mop/ete,) Other <br /> SPRINKLER!St PPR SSION SYSTEM, <br /> Chemical or Water� No.of Heads <br /> ACKNOWLEDGEMENT:t 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 end 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!am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only:_ <br /> f� I T <br /> .;., /24.17 . PERMIT \,(2- <br /> C , - /Au ed A Signature. pate <br /> /Re <br />