Laserfiche WebLink
OIL" PERMIT APPLICATIC ' <br /> BUILDING/MECHANICAL/ PLUMBING I 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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black'Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,2 15 Wtt Lb21� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision rJGL�-� 1 Lot No._ (attach copy of long legal description) ;r j <br /> CONTACT INFORMATION <br /> OWNER NAME: L. 12_1'2- 1 e,i7 `TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 0 I17 VI, <br /> Tkw4® /.:� <br /> .,/ L. s CITY STATE W.,& ZIP 4=1- 21 <br /> OWNER PHONE: 04 • 2 Go T7- d .3-5 OWNER EMAIL: <br /> CONTRACTOR NAME: ' QWf-J <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) 77 •1•"--c....-1-1 tT cid <br /> CONTACT NAME: CONTACT PHONE:LSS 2 01 1. . :,-34- <br /> TC:,t•-,r1:::3cj r2„S'.-f-4 CONTACT EMAIL:rdJp 3t71'Z SEM-4&.,, I-10=4 L.,e.°1-^ <br /> BUILDING.PERMIT APPLICATION - <br /> Existing Use of Building: S -tZ Contract Price of Work.', �".. /"." , ,-.//---„ <br /> /--m%7'. <br /> Proposed Use of Building: PR. Heat Source: ❑Gas lectric ❑Other eX 1 Si"I -}-e--) <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New DAddition Remodel >i<epair ❑T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I r: ta. a -6 r..2 A. <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 #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater ` Bathtub Urinal <br /> Gas Piping BoilerLavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 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 I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION-SYSTEM <br /> Number of Heads <br /> ACKN• LEDGEMENT.I have rev''wed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current -.: -'•state,and local la .The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building• .11 befor. --..•au orized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and!co. jith th-State A tractors Law 18.27 RCW and 296.200A WAC. <br /> ..' City of Everett Official Use Only <br /> I ir <br /> iiit \ PERMIT <br /> Owner/Au ho !zed Agent Signature Ul Date (Revised 5/20/2016) /�' <br /> /tof ,' sia - /� <br />