Laserfiche WebLink
01". PERMIT APPLICATIC. <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 I FAX 425-257-8857 J(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -/{y 0( E.irtyi1reili ii'al PROPERTY TAX#:Z S'4S`p'7 CC'3 00100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Col.ihydoi,ii CisCe;:fif f11 1.,L.Cr TENANT NAME'(If Commercial): Vi ioi?i LItim Delo 0 e i <br /> OWNER MAILING ADDRESS: STREET p(, ,6,1.4 "7,"i O y l <br /> Corr C �&e i o o f{ i fl l :2 7^E3 STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: r 'f„,I R,,,l'tl i(0�n d vvtTlen S rV lye) , )4 L <br /> CONTRACTOR ADDRESS: STREET 0l e 'Y i?)r "f~ii,'ri (e,or <br /> CITY (3i( I�6i r E.(� STATE Li jq ZIP 4.--ii i>2- <br /> CONTRACTOR PHONE: t-17,3".. N' e-ci Sf e D CONTRACTOR EMAIL: .36,191,1 n e r t in ii,i4i nit <br /> CONTRACTOR LICENSE#(REQUIRED): RE'% mit ca 0 iii} CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): T6p <br /> PRIMARY CONTACT: 0 OWNER IQ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4' _ ts,2 )_6 s y0 <br /> &r amie et ge i,), en CONTACT EMAIL: 1j;^niaile e4 f.' E 'c d%t i tr s • t;a rg') <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C <br /> p L t hi et) " ContractPrice of Work:$ ,5-0_,C <br /> r ticknQ <br /> Proposed Use of Building: (0 c h,.nett Heat Source: ❑Gas DElectric� 0Other <br /> Building Type: ❑SFR-Detached OSFR-Attached 0 Duplex DMulti-Family-#of Units: t�t:o�nlmercial ©Industrial <br /> Type of Project: ©New DAddition DRemodel Repair DTI. ❑Sign DSprinkler ©Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> g� eri t pa er444,2144ril0,, I, ,',i reit1frfIn ") i i )cir1'ti I'es, P ri,int <br /> F <br /> 1 f ir'e l)(ME(MIL <br /> peon P c" .,i FF i j,} <br /> P IN 4~Si`l9 :k d i a rete'it5((Vi tI1'I �d .e v je r 01 1'i' dim <br /> `-ASSOCIATED BUILDING PERMIT#(if applicable): StPt/r it 4liar'i4) poi'r'n) I 14 Sr a 11iyi 5 i//fdf ocvi r'f'Al <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration Repair Type of Project: New _Addn _ Alteration _Repair <br /> #of <br /> Fixtures List of Fixtures #of •List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 I SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:t 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.t 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 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 3-2.1-1? lI8.03 — ofi <br /> Owner thor ed Agent Signature Date (Revised 9/23/2016) <br />