Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ti 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION - <br /> PROJECT SITE ADDRESS:#6,2j9 W (,i&j,)t ri ue, suer uJ4- C$203 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:rq-1-(,/ fr/q fq ((14(3Cf I IV/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET l 0 U <br /> CITY C i rejk.1-- STATE Wit ZIP eigzo8' <br /> OWNER PHONE(I12 G 1 3i--54O S OWNER EMAIL: rr/Lf 0Qo,3 4 \/q14 OO co, <br /> CONTRACTOR NAME; „('' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:r-4._— C( l CONTACT PHONE:(/ `45) 31 L'1 j 5l"- <br /> a (IvCONTACT EMAIL: F7-1 it20O.30v61 f00 <br /> BUILDING`PERMIT APPLICATION / <br /> Existing Use of Building: Contract Price of Work:$ I ODD u� <br /> Proposed Use of Building:ad Li 1-4 r'Nf l ) t-Me Heat Source: ❑Gas [ ectric , ❑Other^ <br /> Building Type: MOR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:Zn5 in <br /> eiray �rs t,0 i-(.ie locct44roory Ni,ve,aAutt � two <br /> 6u044n5 p. ramp orae- Bran+ door <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 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 ' 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 /> # <br /> Owner/Authorized nt Signature Date (Revised PERMI 9/23/2016) <br /> //L <br />