Laserfiche WebLink
PERMIT APPLICATION <br /> l 1 <br /> r ., ,. BUILDING/MECHANICAL TICAL./PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> =;zY�,:, s CITY OF EVERT~I I PERMIT SERVICES <br /> •L_. , , u7T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps©everettwa.gov 1 www.everettwa.gov/permits <br /> �.,1 ®:4.1•0lia l(`s' a1 `i(t311.114 is ) ••• , L0.. QJI.' ' qL' liHROIR6)'f1ATI Q 'l :• : ..' ..: . ..... __ <br /> PROJECT SITE ADDRESS: r_ L-G�%v't 7f -r ,4A 5 tE PROPERTY TAX#: <br /> LEGAL for new construction: Short Piaf/subdiviston Lot No. (attach qopy of long legal description) 1 <br /> • <br /> • <br /> I• t"' .'+ •••,.. .. r .w • . ®ick,t`t c'T <br /> c4.04Pbk AT®kt'I . ••••• _ t - ', ,•�J <br /> OWNER.NAME: 1 _Mk k .ilr..+�IM4.141..0.11‘...i, TENANT NAME(If Commercial)— : <br /> OWNER MAILING ADDRESS: STREET I i <br /> c1TY - t! s:'-C".._ STATE ZIP cis:- ., <br /> ,�/ OWNED EMAiL: <br /> OWNER PHONE: 5(•7 isa. r _ . . .... .... ...a, . ,,._ ...� .� .... .� .. , ..... .... .�I <br /> CONTRACTOR NAME: Lt?t 41 :-•Q ' A6 <br /> CONTRACTOR.ADDRESS: STREET 2„,i,2.0 A-0- Le_ ' <br /> CITY 'e.s K STATE (..)-9P4 ZIP OI2fI C <br /> CONTRACTOR PHONE: (42; 1:62.— s5((L( CONTRACTOR EMAIL: i v14...a.s%ovi tug.- <br /> tft i <br /> CONTRACTOR LICENSE#(REQUIRED): E Q2 `3c .---1---- • CITY OP EVERETT BUSINESS LICENSE#(RECUIRED): 0/47'? <br /> PRIMARY CONTACT: El OWNER %CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: . CONTACT PHONE: t. <- ,jam •-0-7 zj <br /> CONTACT EMAIL: _(4.,,4 i 45j)/ ,ret.( 4/4 <br /> • •'•--i, <br /> ' . . • . . •' ' ' iBlll'ithige.PER1Stti`';AIVEre <br /> Use of Building: Contract Price of Work:$ V / o • <br /> Existing • <br /> Proposed Use of Building: Heat Source: °Gas °Electric °Other , <br /> Building Type: °SFR Detached EISFR Attached EIDuplex ElMulii-Family-#of Units: °Commercial ElIndustrial. <br /> Type of Project: °New 1:Addition °Remodel °Repair EIT.I. °Sign °Sprinkler ElDemolition °Change of Use <br /> DESCRiPTION OF WORK: OA `' W, j •a ' � � t'�stz., <br /> • <br /> ASSOCIATED BUILDING PERMIT if(if applicable): _ <br /> '.'. $C 4AN11CAL PE hi fT W04- 0.N. • • . ' ippI,i1 ilgiN® 1 0111 4l6?? l< �Tl'li®M R . <br /> Type of Project: New Addn .Alteration_,Repair Type of Project: New Addn AIterafton Repair <br /> of #of °f List of Fixtures I #°f List of Fixtures <br /> Fixtures List of.Fixtures Fixtures List of Fixtures <br /> Fixtures Fixfuras <br /> • <br /> Toilet Backflow Preventer(Inside Bldg) <br /> A1C—Air Handling Units ! Heat Pump Bathtub Urinal <br /> Forced Air Systems Unit Heater <br /> Boiler Lavatory(Wash Basin) I Drinking Fountain <br /> Gas Piping Shower I Floor Drainp • i <br /> Water Heater Refrigeration <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal I Grea e Tra <br /> Gas Range Ducting Dishwasher <br /> Other: Clothes Washer i Medical Gas <br /> rains <br /> IClothes Dryer Hookups Water Heater Other: • <br /> Ex Hood 1 <br /> Exhaust <br /> Fan Sink(Service/Bar/Mop/etc.)! Other: <br /> Number of Heads _ <br /> tCKNOWLEDGEEMENT'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 /> s rrent federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must fIrst ha authorized In writing from the <br /> luild/ng Official before being authorized under any circumstance,lam the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> ed/comply with theStet Contractors Law 18 W and 296.200A WAG.67- 6- / <7 i City ofEVereft Official Use Only <br /> 1PERMWO <br /> 6` <br /> L. "� Date (Revised 5/20/2016) <br />