Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OLT 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:btfl CE €U'R ETT ANA U. vJA-i cvwn.e?r „vPLPROPERTY TAX#: <br /> Lo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. 9(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1Ps-k . E' <rm,M4 .e 21 TENANT NAME(If Commercial):Dm_ C ptti <br /> OWNER MAILING ADDRESS: STREET rQ�1 St €viii vv -r AAA-x, <br /> CITY E vE 1 77— STATE ZIP r F(2-0 Sj <br /> OWNER PHONE: dl25. 3 SI7 I(per OWNER EMAIL:Q_A 0 2-O`3 Qk\•'13'40 6 Cts pn <br /> CONTRACTOR NAME: 7"E N,A„:1-r L�1 Tt✓J`— <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE , ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �,,/) CONTACT PHONE: (412. . � -• I US <br /> L A ch >�470CONTACT EMAIL: <br /> BUILDING PERMIT,APPLICATION <br /> Existing Use of Building: F&D -CS rel i L1SN fes'" Contract Price of Work:$ TOo, o <br /> Proposed Use of Building: Heat Source: EtGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-f#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> POuCd+ IN Q--)T4s rite <br /> ASSOCIATED BUILDING PERMIT#(if applicable): P)1. t <I.— 0 3 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: New Addn _Alteration _Repair <br /> #ofList of Fixtures #of List of Fixtures #of List of Fixtures #of 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 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water f 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 Contr.cto Law 18.27 RCW and 296.200A WAC. <br /> /// City of Everett Official Use Onty <br /> / PERMIT# <br /> /6' / � 1� <br /> .-. •.•'l ��" <br /> OwnerlAuthori <br /> gnature Date (Revised 9/23/2096) <br />