Laserfiche WebLink
PERMIT APPLICATION <br /> • <br /> BUILDINCalECHANICAL/PLUMBING/SIGN I' I#'RINKLER/DEMOLITION <br /> el14A44;"-A CITY OF EVERETT PERMIT SERVICES <br /> J J 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blu*144kI Onl Please) ., ., , ECTSITE NFO . , , _, 1 , ia *e7 <br /> PROJECT SITE ADDRESS: 30LS PROPERTY TAX#: or)4.51 V41.101360 <br /> LEGAL for new construction: Short Plat/subdivision tw.. 41 1 P-00 Lot No.)'r✓'/'to(attach copy of long legal description) <br /> 5 z" 'cu ,fir ,t x e. -t �a,.✓,"• rfi <br /> OWNER NAME: 3- Gib Ito v 1-tiet ri TENANT NAME(If Commercial): 14612 01C,146A-ern sgrv. <br /> OWNER MAILING ADDRESS: STREET02.5 Vuf..((„ .., MM cj <br /> 6\1 / <br /> CITY STATE U) 34 zlrg 21) -3151 <br /> OWNER PHONE: -U'(e. 0144 a 72,1 OWNER EMAIL:'4 pitm. , 1P-.6 <br /> CONTRACTOR NAME: PE* Ce)ti -1"Y'l46 ,(A, <br /> CONTRACTOR ADDRESS: STREET P12 $per 2J t <br /> CITY Newby)l( STATE wFI ZIP gp3147 <br /> CONTRACTOR PHONE: 7.040 471 .0,0 11-- CONTRACTOR EMAIL: JO 4* ?&,,,9m&t i GOWN. j$nit <br /> CONTRACTOR LICENSE#(REQUIRED) M,5(„7�4� bc_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR .PTHER(Please Specify) nif ivo . ref a5EP `6 UTs <br /> CONTACT NAME: CONTACT PHONE: 9f0 64T-60 2-- <br /> --d0&d-b& YA <br /> GL Z21 t Ii(D CONTACT EMAIL: \:4es.. 1'KA 1 <br /> Existing Use of Building: M1DtCAL Contract Price of Work:$ ,V4 I t Oa 0 <br /> Proposed Use of Building: N460( '(y Heat Source: I' bas ❑Electric El Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial El Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: MI V &Kw of eL.wait S 4lML{doom Ayt_ 74f,G4't'014 pi-.MA,AJ- Wa.Lts <br /> dOO frog pry offtzc)j pcatc --hreaftw,R- a-5/ a2. '4(ale vrtiivont <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 #of List of Fixtures <br /> Fixtures Fixtures ixtu 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 'j,. 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 I 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 /> ,� J• <br /> PER # <br /> 110 e 6a02( 503-.V3;•/ <br /> 50 3- ; <br /> n3 <br /> Owner/Authorized Ag t Signature Date (Revised 9/23/2016) 1/ <br />