Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> OLT <br /> CITY OF EVERETT PERMIT SERVICES l <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> (Blue nor Black Ink Only'Please) „ <br /> RROJECT SITE INFORMATION <... .` _, ,.._` ... t_.. = :.. <br /> PROJECT SITE ADDRESS: 7 I1 H(.... Ker ,4"v . PROPERTY TAX#: OL%41 I3 ,Off-/00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> REIRENOMPIMERMIng _ tCONTIACT INFORMATIONMt.... ,.. <br /> OWNER NAME: !R aer911/ C rce-ri TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j7 I , II C",-- �,Q...4 Ave_ <br /> cITY r 14(0P--- STATE V.1.44._, ZIP c rq 2 0 1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 64-.5 (--i&art� y <br /> CONTRACTOR ADDRESS: STREET 13410`c( r...- :. - '. <br /> ' 4 I/ <br /> // <br /> CI Y E-V P/IV .^. STATE k,"// ' ZIP C(R. 2 0 I <br /> CONTRACTOR PHONE: 1./2 r6J4)�--gz...7' CONTRACTOR EMAIL:d ,p' 1,,, %.a-a 1-k'Q.-Eit fre•ce7141 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:iy2F 30Cf.G,0,7 <br /> 19"e-41-1-----1 rte.timAii CONTACT EMAIL: 1 <br /> BUILDING;;PBRMITrAPPLICATI.ON ,, _ <br /> Existing Use of Building: i-(ckm.t0 Contract Price of Work:$ 'I1 I 0P & <br /> Proposed Use of Building: i-{c,t,'vi Heat Source: ❑Gas I Iectric ❑Other 9 <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: El Commercial El Industrial <br /> Type of Project: ❑New ❑Addition pi Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK S ty, e- t �3 f& <br /> , <br /> G�l�'�1' IJP.^' � �,- f"+.C',eµ.�� {��, tri' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMB.ING:PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units I 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 /> SP,RINKLER,./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 grantin 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 authorizedyndC 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 Contractofs Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> ' ''''H,`-'' ':"?.--'''' <br /> 1 .- . PERMIT# Mv-10-1— 0,A <br /> Owne uthorized Agent Signature Date (Revised 9/23/2016) <br />