Laserfiche WebLink
PERMIT APPLICATION <br /> ellP-- BUILDING/MECHANICAL 1 PLUMBING/SIGN/SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857"I(E)everetteps©everettwa.gov 1 www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> . . PROJECT SITE ADDRESS: 37/ Ave_aat to tokPROPERTY TAX#; <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: , d t. TENANT NAME(If Commercial): ►s ( C, 1 <br /> OWNER MAILING ADDRESS: STREET <br /> QITY STATE ZIP <br /> OWNER PHONE: X06 — WjC °~°~ 10/18 OWNER EMAIL: .a(A P X 1 e, ,to ,g <br /> CONTRACTORNAME: „:x6d4("t' tic f <br /> CONTRACTOR ADDRESS: STREET �1 <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 'Vire *\� <br /> CONTRACTOR LICENSE#(REQUIRED); Ex,abED0 eto , L,,, : TY OF EVERETT BUSINESS LICENSE#(RE's UIRED): 1 Y,I <br /> edd <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR D OTHER(Please Specify) —e% <br /> CONTACT NAME: CONTACT PHONE: - <br /> CONTACT EMAIL: „ e...6, <br /> .3 t 7 IIS t <br /> cerok <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 'contract Price of Work:$ A.--pi <br /> Proposed Use of Building: Heat Source: El Gas ©Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached ODuplex` OMulti-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New OAddition ❑Remodel DRepair OT.I. OSign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: p p <br /> qq <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 #°f 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(ServicelBarlMopietc.) Other: <br /> SPRINKLER(SUPPRESSION SYSTEM <br /> Chemical or Water ) No.of Heads <br /> ACKAIOWLEDGEMEN7: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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18:27 RCW and 296.200A WAC. <br /> ., City of Everett Official Use Only <br /> PERMIT <br /> 1217 / <br /> Owner/Authors 1Agent- ;nature Date (Revised 9123!201 .,: z.)‘ –.-2`Q <br />