Laserfiche WebLink
PERMIT APPLICATIO <br /> BUILDII`MECHANICAL/PLUMBING /SIGN I RINKLER/DEMOLITION <br /> A "� 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I q 2—1 t 00 U5 G ii ptki.€ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ao -I 01 (? v_ 'J r• TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET q 32(� , Ho II li 40 r it -A <br /> CITY S/ �4 ( STATE w A ZIP 99.201 <br /> OWNER PHONE: 12--S-2, J`LkGCr '1 , OWNER EMAIL: <br /> CONTRACTOR NAME: —ThQ I�lUmh (RA o na pec VI <br /> C-y Du. 1 LA. C <br /> CONTRACTOR ADDRESS: STREET g22 2 'h c\ <br /> CITY GPQ 4Q STATE WA ZIP [E3)22 <br /> CONTRACTOR PHONE: 206-Ej 12-2A21 CONTRACTOR EMAIL: con-0c-1 e p1-15 pr n .corn <br /> CONTRACTOR LICENSE#(REQUIRED)::�'1 0 1 1?,PH 9.41 H'' CITY OF EVERETT BUSINESS LICENSE#(REEQUIRED)• �"� <br /> PRIMARY CONTACT: 0 OWNER Ca'�ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: X125-"I 01 -1 6 I <br /> -1 1CtC1 CONTACT EMAIL: °nc e se p 1 pro c C°re <br /> BUILDING PERMIT APPLICATION ( -----, <br /> Existing Use of Building: Contract Price of Work $ 126 0 ,0 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition model ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I\ <br /> picamh In, 0c)cr1h- I r) a S '-€4 arid. s 1 A V . `oi ok 6,0,14 tovrvt. <br /> o.,asOCIATED BUILDING PERMIT#(if app li cable): C 1611-0 I 0 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ew_ Addn _Alteration _Repair Type of Project: f...---Flew _Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 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: i Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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.I am the owner,or I am 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 296.200A WAC. <br /> City of Everett Official Use Only <br /> L <br /> .rn� I2e,.Oc;,.. , 0223-11, 1' LA2_ —06 .2. <br /> •wner ut, zed Agedt Signature Date eri O/ "^AC' <br />