Laserfiche WebLink
PERMIT APPLICATION 1�ii��111 <br /> BUILDING I IICHANICAL/PLUMBING I SIGN I 'RINKLER 1 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2T?'- i 2_r-t' ST- PROPERTY TAX#: 2.`7O S-1700 /03 2Qf) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: EV-fe 1'rOt5) go6 raill4 , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3(0`] Ccs( �j i i r V �Z- <br /> cr, _J£- ET\' STATE WVV ZIP 9B2_0t <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T.. D. <br /> CONTRACTOR ADDRESS: STREET <br /> CIT' STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: fialOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: - 2"5'- 2_01-3 1 T' j ©i,i Ly <br /> ''$ci-s D5 k-\-1__L:7-#.-,C_ CONTACT EMAIL: ,f-pr ��r � ►'1 Q 1 , r <br /> e`/ '• • , C5-.e^� <br /> BUILDING PERMIT APPLICATION •,J 1 <br /> Existing Use of Building: A(.r-4'ni.€..t 1-S- Contract Price of Work:$ "" (220O `— <br /> Proposed Use of Building: Sfj-cviel .� Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex IJMulti-Family-#of Units: ti CI Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ORemodel ❑Repair OT.I. OSign ❑Spr`inkkler ODemolition OC ange of Use <br /> DESCRIPTION OF WORK: A( ,c.- Acc s --6`Q L-T. ) f S 4o (J r 3 <br /> tom; <br /> • ` /� ..)C-le---4./-311. /Tra <br /> ASSOCIATED BUILDING PERMIT#(if applicable):�-+�'4 e✓ �'I-').�� - -� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New— Addn _Alteration _Repair Type of Project: _New Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ____ e___ ki.1 -7:- 3- I PERMIT# <br /> 7pn <br /> 0 � ©5U -- <br /> - <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />