Laserfiche WebLink
PERMIT APPLICATIOI^ <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> /°.1$1/'-14.18/:-1. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 712.--5 mitK/ 9/s7/U/Ef,A-gat--7)- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,::1,4:92.4....*:. ©/1/$, -741/75 L-1- C._ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET/(6Z/ A/4--- (66,-r`" Si. -{'� <br /> CITY fiv(,',tie; STATEU/f. ZIP /61---- <br /> OWNER PHONE: -006----- -- ,---z--z-1/ OWNER EMAIL:/,V/ 2 lG. p rD ,le,%7 7 t'flv5• Cc�/1/f <br /> CONTRACTOR NAME: 0h4_,Aie C / <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: arOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: eeeee,-7.9.9-/ "----z,,-- <br /> a( OS ` CONTACT EMAIL: //yfepetWG I.rC-ficte+zz)�l�t •c e,4. <br /> BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: • F/""z <br /> Contract Price of Work:$ 1wdt, 14---------- <br /> Proposed <br /> -----~Proposed Use o,ffBuilding: SF P- Heat Source: ❑Gas ❑Electric DOther <br /> LJ7 <br /> Building Type: SFR-Detached ❑SFR-Attached ��//❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel E Repair ❑T.I. ['Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> tepAlcZ/U/32/1-77:- --e-OC-7/44,11 4_ I ..02.4 <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 /> NC-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(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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.-w 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /�/e, <br /> PER `- O�orized A e �i re iDate <br /> Owner g !� g (Revised9/23/2016) <br />