Laserfiche WebLink
PERMIT APPLICATIOPERMITNSERVICES <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> '1111P//00 " •A <br /> CITY OF <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Bliie or Black Ink Only.Please) - PROJECT.SITE INFORMATION • • . <br /> PROJECT SITE ADDRESS: 3115 Pi ivE PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> •• - . . .CONTAC` ..INFOltiVIATION • . . <br /> OWNER NAME: Flue S'T t W(T ►Lt-ty (_L.&. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Ili ti.Cu- e.evc4 '( 451.6(6 c <br /> CITY B ell lwt> M STATE IAJP ZIP Tk zs <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C I( e,02.456 A..) ✓ria-Tf( `a(-4E jiLj,6T-A-C_ <br /> CONTRACTOR ADDRESS: STREET 212C) P,q(...i fit. AU Gr <br /> CITY GUG(2u't r STATE W - ZIP I4d20( <br /> CONTRACTOR PHONE: 4 25.2-5.2.-13//4 • CONTRACTOR EMAIL: frukske£S9mw4„,e04"- <br /> CONTRACTOR <br /> CONTRACTOR LICENSE#(REQUIRED): .(Jis�2(s.3s 022_0 r (CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Cs 61 ei S5' <br /> PRIMARY CONTACT: 0 OWNER ( (.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NA CONTACT PHONE: 47c-25-2-'5/0 <br /> mvu& CONTACT EMAIL: tai.Q c.c <br /> BUILDING PERMIT APPLICATION <br /> • <br /> Existing Use of Building: l Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: Inas ❑Electric CI Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: IN.Commercial CI Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel IBRepair DTI. ❑Sign ❑Sprinkler ❑Demolition CI Change of Use <br /> DESCRIPTION OF WORK: <br /> Li (� 5 PTA( W i lik liet3s t coni I t4i io t5 4r 4 u <br /> 0404 5 t...- t-‘45, tit 171-65. Mt UN(±5 B44-0 LA eolikitit6v- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . ' .MECHANICAL.PERMIT-APPLICATION . • PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration t Repair Type of Project: ^New Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units `s 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 /> Number of Heads <br /> ACKNOWLEDGEMENT:l 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Officoat._ial Use Only <br /> onr\00? - _ ^ s....1 1(1 PERMIT <br /> irvi riOwner/Autho Agent Signature Date (Revised 5/20/2016) <br /> 6:1;___) <br />