Laserfiche WebLink
PERMIT APPLICATIOI—• <br /> eij,,,%Z.--. BUILDII�IIECHANICAL/PLUMBING /SIGN I IlikINKLER I DEMOLITION <br /> Nisiggd <br /> CITY OF EVERETT PERMIT SERVICES <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.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 31z6 Q.Js Ave Evert f#,VJ/F' 8ZO( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t"'{GIJS,v 40(:).e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: t OWNER EMAIL: <br /> CONTRACTOR NAME: $t'o f f c..k 1kAmse-0004 (40 s4otv\. OS-) <br /> CONTRACTOR ADDRESS: STREET •7733 Wes+ (3c r;CA <br /> CITY t kik)oG 8IN...v t 1,� STATE WZIP 1 80-1- <br /> •' ... - •- '-• - 64 2 s} -I I q ��jqq CONTRACTOR EMAIL: S lAovi.tcVe I k 1 @. t( s ,'J_ S <br /> CONTRACTOR LICEN • `'EQUIRED): (<L(,S 1 DU� vL{1 A 6 CITY OF EVERETT BUSINESS LICEN (REQUIRE ; PJ24's <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 5\faf E-c_/� (ICgMg- I> ci CONTACT PHONE: (14 7_61 q f(1-6 qqg <br /> CONTACT EMAIL: s 1,\,,y. Eche I(CC M9 €ICUs4 . US <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 2Sc5C--) <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Fre 86vYtase, ceciattr1 Mk it dry Wal( c(AeS, (c-ick c tort -recNekc•ei New Pac..rr. I <br /> AHinP'i>\."1-,nl"W.51,04er,JIshw<sktr; sun IG, <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 List of Fixtures #of List of Fixtures #°{ List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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 t Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> l Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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.Ileviations 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 /> / PERMIT# City of Everett Official Use Only <br /> �I.% 6� 40-7 (� ioq. 00 -j <br /> . . • i orized Agent Signature Date (Revised 9/23/2016) <br />