Laserfiche WebLink
PERMIT APPLICATION 1 11I1 <br /> 00.10, BUILDING I N CHANICAL/PLUMBING /SIGN /:JNKLER/ 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2.:7 3 1 I .. ' ST- PROPERTY TAX#: 2`j0 S-1700103 20. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: EVEt2t1T V 00.5) J 6 trUll- . TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3(/3-7 Co( qsi A' xi(Z <br /> CRY _v�•e_ r STATE '1/4W 4- ZIP 9 52_0 k <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 7-R N) <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: igrOWNER 0 CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: f.fJ c <br /> Z - � l`"3 - '�� S , ©p > <br /> -ti-t s:_o5 i l-\',-LLLl- j CONTACT EMAIL: d- fck k Q e- i 1`1 , d'� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: A-4),13.r-4-r .&r j '}-S Contract Price of Work:$ € && ti, 2.00 <br /> Proposed Use of Building: S tomo�. Heat Source: ❑Gas @Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex QMulti-Family #of Units: Li ❑Commercial @Industrial <br /> Type of Project: ONew @Addition ORemodel ORepair OT.I. DSign OSprinkler ODemolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> I / it II / I . i, an , �� ��yr .I��+� iur...:�! 1 �.,rce_ / i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 50.JL,0.r- e.X-i CJ„i 9 t.J�.\-I to r.► Y. <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 /> 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 Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water II No.of Heads <br /> ACKNOWLEDGEMENT:1 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 a 3- , - PERMIT#^ f^ O - 05.Z- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) l6 <br /> ..„)L <br />