Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5 31 (51' Ave 5 6 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: o kt4 �'�k€1j ( f�e i `(r(6' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (JS(RO A Ca)vis`i71),b/"-- 4 6. (. <br /> CONTRACTOR ADDRESS: STREET 13 yz.6 Z.Z./.ed Gc/-v e � . <br /> CITY dv(.t1(( ‹ STATE v � ZIP ?go a 1 <br /> CONTRACTOR PHONE: gd 4'7( f33" 3 CONTRACTOR EMAIL: 1. (eI siva n wC (o�y <br /> CONTRACTOR LICENSE#(REQUIRED): _65,(7,-(0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER ltd"CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t 41'7 I 5303 <br /> tQ �r 4 75� CONTACT EMAIL: ,,v( r <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 0, <br /> Proposed Use of Building: Heat Source: El Gas Delectric DOther <br /> Building Type: DSFR-Detached ❑SFR-)ttached ❑Duplex ❑Multi-Family-#of Units: DCommercial El Industrial <br /> Type of Project: ❑New DAddition emodel El Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> )I45' -1( rue- ' Dcc f kik'?e,, %ood UI' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PyRMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #ofList of Fixtures #of 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 I Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> I Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I <br /> p � �' Ir City of Everett Official Use Only <br /> a—AegZ1— C D PERMM, tO1 — <br /> �ly <br /> Ow er/Authorized Agent Signature Date (Revised 9/23/2016) <br />