Laserfiche WebLink
1 I <br /> PERMIT APPLICATION • <br /> BUILDING I MECHANICAL/PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 lFAX 428-287-8,867 ICE)everetteps@everettwa.gov l www.everettwa.goviperinits <br /> (Blue or BlackInk OnlYPIeuee) 'PROJECT sin INFoRmATION 7 <br /> PROJECT SITE ADDRESS: seg E P41-r PI c ti f II Al.t.c. PROPERTY TAX 4: ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ' ' • <br /> OWNER NAME: 13(R t tki"Q CA)LAjc-4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5a.. 451- Mai I L-1-• AVG <br /> CITY (:0:Val1 STATE Wilr ZIP / e ifoq <br /> OWNER PHONE: /..1.45"-- 3.ve- 71/3 OWNER EMAIL: '4.LiedK'MOO? e $ihot ,e., vii <br /> ,„ / 1 i„,, ,... <br /> CONTRACTOR NAME 73,..!, iet. cl. ,y)-e rty .,-9,14.,ri tie 1 3 <br /> CONTRACTOR ADDRESS: eraser 10-7 3 i17.1%.—Pit: We-sl- <br /> CITY iyi 0116-1717,!...6 STATE iftiii ZP 1111;7.-7 CONTRACTORPHONEPHONE: LiZiff"- IN.3...- ,1-9,-3 CONTRACTOR EMAIL lir tft I1-4-eg be,/id .Iv11 <br /> CONTRACTOR LICENSE#(REQUIRED) B115(*et-. CITY OF EVERETT BUSINE4 LICENSE#(REQUIRED): L/62,i1 <br /> PRIMARY CONTACT: gOWNER 0 CONTRACTOR 0 OTHER(Please Specify <br /> CONTACT NAME: v CONTACT PHONE: 1-42f--- 5y/ - 71,- <br /> ,/,..,A,...- , ..., , <br /> Be,ail 6(,)Iv t..1 , ,7 CONTACT EMAIL: &vex;fn ato I' At of hap.eate-vo <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 2_21(X). p° — <br /> Proposed Use of Building: Heat Source: °Gas Ntlectric ElOther <br /> Building Type: OSFR-Detached MFR.-Attached ElDuplex ElMulti-Family-#of Units: OCommercial [Industrial <br /> Type of Project ripew ClAddition IDRemodel EIRepair Ott 0Sign EiSprinkier ODernolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 4. <br /> - 2") . <br /> 1.--I k•e'' - -- )4l r) 3, Fueewet- WICO-Urtt lAt <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addl., Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of #of #of # <br /> Fixtures of <br /> List of Fixtures List of Fixtures Fixtures <br /> Fixtures Fixtures List of Fixtures List of Fixtures <br /> NC-Air Handling Units ________ Heat Pump _ Toilet Backflow Preventer(Inside Btdg) <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 8,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/Moptetc.) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:!have reviewed This application and confirm the information contained herein is true end comet.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(he 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 ROWand 296.200A WAC. <br /> City of Everett Official Use Only <br /> , <br /> PERMIT L14 <br /> / 0, <br /> 1/6gi7719tr (-' -- <br /> . Authorized Agen Signature ,., ., te (Revised 9/23/2016) <br /> 0,7 <br />