Laserfiche WebLink
PERMIT APPLICATION <br /> '1101$4 —g BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7j 0cj N-0VL'renN D'n/' PROPERTY TAX#: 00g' Ss 7 op-1O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C' 1/' (,`'( rot--64 N-1.1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '.7, s tstresstc-N <br /> CITY vrexeTi STATE I* a ZIP 9 2-0, 9 <br /> OWNER PHONE: ?.) C2I +7 21 t + OWNER EMAIL: ,-}—t/( i .(D ( v 4 L (`r� iV1G) i�944( l •crmi <br /> CONTRACTOR NAME: OW tip/K <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ( OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ,:=7\."2-1:,_ Contract Price of Wor : $ ty CC' <br /> Proposed Use of Building: Heat Source: DGas ❑Elec c DOther <br /> Building Type: OSFR-Detached DSFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. OSign ❑Sprinkler ODemolition DChange of Use <br /> DESCRIPTION OF WORK: 1 v4t\AA-t'e-ivici )C��iTf <br /> rY fr''I-S e)V/ 41 or r- IPOI -c*t- gey>l.pt - SlA10-0'14 <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 Listfof Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet ackflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit H-, er Bathtub Urinal <br /> Gas Piping Bo -r Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater 'efrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispo Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Was Medical Gas <br /> Range Hood Water He r Other: <br /> Exhaust Fan Sink( rvice/Bar/Mop/etc.) Other: <br /> SPRINKLE ' I SUPPRESSION SYSTEM <br /> Chemical or Water 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 /> PERMIT# <br /> 7/ hi (` 6 <br /> Owner/Authorized Agent ignature Date (Revised 9/23/2016) <br /> Ci � <br />