Laserfiche WebLink
PERMIT APPLICATION <br /> ef ih/III BUILDING 1 MECHANICAL 1 PLUMBING (SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> #' 3200 CEDAR STREET,EVERETT,WA 98209 <br /> (P)425-257-8810 I FAX 425-257-8$57 I(E)everettepe everettwa_gov I www.everettwa.gov/permits <br /> (Blue er Black ink Only Please PROJECT SiTE INFORMATION �` <br /> PROJECT SITE ADDRESS: 61/2— (' f C)r PROPERTY TAX#; ,f . 7,066 /10 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> it■ r : '... , <br /> IrII1�uW�•y <br /> IA/ .CON ACT INFORMATION <br /> OWNER NAME: du I Af , •f _ tr i TENANT NAME(If Commercial): ,--- <br /> OWNER MAILING ADDRESS; STREET ,r i <br /> : Q 4? OY 56 <br /> . -. STATCITY ve +e, -- . r.�4 .p g- <br /> OWNRPONE12_j-wjL " LOl <br /> .— WNER omit.: ! _ <br /> 2 M <br /> • <br /> • <br /> • <br /> CONTRACTOR NAME: 0( J 1?) + IA), tL .1-16-7/376--& <br /> CONTRACTOR ADDRESS: $TRaaT 1--il ...Zi( v�.- ; 5( - DX o f J2L � <br /> Cm,i?-er,�iJ ivy) sTA'CE [,if/ f ZIP } L! <br /> t <br /> CONTRACTOR PHONE; 4z4483- ` g7/ O CONTRACTOR EMAIL: 4j 17/4.6 Basin—iia' C[f _ <br /> CONTRACTOR LICENSE#(REQUIRED): 1410--r�1 glgil6 ' kr(OF EVERETT BUSINESS LICENSE#(REQUIRf;D}: 6, � <br /> PRIMARY CONTACT: 0 OWNER fir ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTr �NAME- �p CONTACT PHONE: " '1 1.r3 TC/P / <br /> V � L js CONTACT EMAiL: ( ,I>it'{fig- f� A & .&i _ . <br /> M r B. LIMING PERMIT APPLICATION <br /> Existin• Use of Building: f. .' 'f t / Contract Price of Work;$ 2-' • <br /> Proposed Use of Buildin.: Heat Source: MOse ❑Electric ❑Other <br /> Building Type: reR-Detached ❑SFR-Attached ❑Duplex ❑Multl-FSMil4ofUnits: ❑Commercial ❑Indu -- <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T,I, ❑Sign ❑Sprinkler ❑Demolition IJChan•e of U jIretrif.fttefb4 <br /> DESCRIPTION OF WORK; ‹�_ y/ <br /> R-riol ixt -4- zepiw., 1 9 to___, (Joifie/v/ti ,-or <br /> ASSOCIATED BUILDING PERMIT#(if applicable): . - _ —... � <br /> MECHANICAL PERMIT APPLICATION ' PLUMBING PERMIT APPLICATION <br /> Type of Prosect: New _ Addn _,Alteration _Repair Type Of Project: _New _.*Addn _Alteration _Repair <br /> Fixtures List of Fixtures Ffx#tur-s List of Fixtures Fixtures List of Fixtures �Plx u as List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld , <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipin _ Boiler Lavatory Wash Basin) Drinking Fountain <br /> i 1.111111 Refrigeration _ Shower Floor Drain <br /> Gas Fire.place 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/BariMosietc.) Other: <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,Strife,and focellaw, 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 8uthorlted under any circums ca,/am the owner,or!am authorized by the owner of this property 10 perform the work ror wh!Cli application is made, <br /> 8 • • = with the Stale Contractors Le.• 8.27 RCW ••296,20OA WAC. <br /> p n , � City of Everett Official Use Dniy <br /> r' 4. �`"�f,(J, r �.- pia Ii,T I ibb2 621 ,tom <br /> r <br /> !J'��J <br /> Owner/Authorized Agent Slgnatiire Date (RevL c.5/20/2016) <br />