Laserfiche WebLink
Jan 23 2018 12:24PM Washington Wate' ters 8663757454 page 1 <br /> ar PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN/ SPRINKLER(DEMOLITION <br /> CITY OF EVERETT PERMIT SERV;CES <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.govlpermits <br /> (Blue or Black Ink Only Please) ,��V PROJECTPROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Zq){ L f 4k L' � L PROPERTY TAX#: 01)43q tgaq a <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C,(,)I I Y 1,.G R( P 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �L,( t GYV..J6kY L ()ewe_ /y <br /> ciin ..l1i - V`' 4 STATE WA TIP q m)I <br /> OWNER PHONE: 47,6,--16?"-763o OWNER EMAIL: <br /> CONTRACTOR NAME: WA-5141A)677-66.) jz(1 01-.1-tit Hc137 6-a t� <br /> CONTRACTOR ADDRESS: STREET (115j Z 1/ ti s-- 4-vt 5 '- rT-�7 r 6 190X ✓/2O d <br /> CrrN P-eYid-art STATE W is+ ZIP f t <br /> CONTRACTOR PHONE: 424-g3- WV CONTRACTOR EMAIL: 609-1,(J/t-H'1//4-[ Cnt+pti t( arm <br /> J`/�; <br /> CONTRACTOR LICENSE#(REQUIRED): (Q quo CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 5 17"/"7 <br /> PRIMARY CONTACT: 0 OWNER L CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT N1AME• CONTACT PHONE: t/�• .g3-ca 71 <br /> V11-C/NAME, �+u I41' IS CONTACT EMAIL: tObl-GU1 •ilZ;41.C_@ 6irL,okkr <br /> BUJ DING PERMIT APPLICATION 77�� <br /> Existing Use of Building iLS�C V <br /> ] Contract Price of Wor :$ ILO <br /> Proposed Use of Building. Heat Source: LQa DElectric ❑other <br /> Building Type: ntil,--Detached ❑SFR-Attached ❑Duplex IJMultf-Family-#of Units: ❑Commercial Din vial <br /> Type of Project: ■New ❑Addition ❑Remodel DRepair OT.I. ❑Sign ['Sprinkler ❑Demolition ❑Change o se <br /> DESCRIPTION OF WORK: <br /> elibljt L, V-- .', 0'a. / Uvui / iaJ4 <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 Adds Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Firma List of Fixtures <br /> Fixtures List of Fixtures <br /> NC–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 Healer Other: • <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER l SUPPRESSION SYSTEM <br /> [Number of Heads <br /> ` <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,end 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 circcanstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Slate Contractors Law 78.27 RCW and 296.2 WAC. <br /> City of Everett Official Use Only <br /> nt <br /> (-23-/r <br /> PER T <br /> \(Q l ' D9g <br /> (Authorized Agent Signature Date <br /> (Revised 5/20/2016) <br />