Laserfiche WebLink
PERMIT APPLICATIOIN <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> "Ii°410/Ad://:----4 <br /> CITY OF EVERETT PERMIT SERVICES <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 /> ( <br /> (Blue or Black Ink Only_P(ease) PROJECT SITE INFORMATION _ <br /> `PROJECT SITE ADDRESS: 2J. 5. WETMV1 OiC/RJ F- I7 4.),4,. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> r ' CONTACT INFORMATION <br /> t OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> WNER PHONE: OWNER EMAIL: <br /> [CONTRACTOR NAME: . N Otv Mi I.JE JuNP�A0 is -'S <br /> CONTRACTOR ADDRESS: STREET ‘`P 12 131 !Ave. fJ,e , if <br /> CITY LAKE 5 eJE 5 STATE w A , ZIP ci.t'j26-j <br /> CONTRACTOR PHONE: 92-S.- q ., 4.4 gef CONTRACTOR EMAIL: i n sp,'r.e cw j.1/, 1 ec o3 OJ Ma, 'I. caw, <br /> CONTRACTOR LICENSE#(REQUIRED)JISNJov re BSS,P t{ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 05652-3 <br /> PRIMARY CONTACT: ®;OWNER 0 CONTRACTOR 0 OTHER(Please Specify) (142-57)93/-- (o(v f5, <br /> CONTACT NAME: CONTACT PHONE: <br /> b,iZE1J 5/i711--E5 CONTACT EMAIL: <br /> ., - BUILDING PERMIT;APPLICATION <br /> Ai <br /> Existing Use of Building: Contract Price of Work:$ �✓"�� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition EiRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> tAi klILI4 6t19SPC 5 vez - - ' ry c 6 i' 5,,o c of 1-kz204� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APP KATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New Addn Alteration _Repair <br /> #of #of List of Fixtures 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 I Other: j � yy <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) I Other:W+1) kovL) <br /> _, ._..SPRINKLER I SUPPRESSION SYSTEM .. <br /> Number 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 /> nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � PERMIT# <br /> � � 'Date � 1..... oD <br /> Lk <br /> Kr/Authorized Agent Sign Date (Revised 5/20 016) <br />