Laserfiche WebLink
14err PERMIT APPLICATIOIU <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /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 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink OnlyPlease) PROJECtT�:SITE INFORMATION <br /> PROJECT SITE ADDRESS: AlQ j' L c54 *c9c0t i PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION. <br /> OWNER NAME: � tt.,e,„ TENANT NAME(If Commercial): f8, e 1] <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR te OTHER(Please Specify)1 tum; �� � � <br /> CONTACT NAME: CONTACT PHONE: LJ a5 Sv5_ a , <br /> (4) <br /> CONTACT EMAIL: 3u S s,cv ‘ . S C�T`/l c ta,a_ <br /> 'BUILDING'PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ a 8`OO <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel El Repair ❑T.I. CI Sign El Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> e\L\POLAAik <br /> ASSOCIATED BUILDING PERMIT#(if applicable): .61 (O("O <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 Fixtures Fixtures <br /> Q NC—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 4, Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 2._ Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER%`SUPPRESSION SYSTEM, <br /> Number 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.lam the owner,or lam 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 /> PERMIT# <br /> �1�e� �� 1 (oOi 01)(o <br /> Owner/Auth rized gent Signature Date (Revised 5/20/2016) <br />