Laserfiche WebLink
PERMIT APPLICATION■ <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ifg77" 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:a q3. L ` alk r p(/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision C./S Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C ��(`w 1f P T2 4--0 LL(1` TENANT NAME(If Commercial): <br /> OWNER MAILINGLADDRESS: STREET L�+�gal I/c P r f,r� <br /> v 1 c 4'01'4'2 T'J_� \cb_te I STATE i nr /7 ZIP ,g-y(O f <br /> OWNER PHONE: LA S, �S�—o( 2.O y l OWNER EMAIL: N �/ ' "` c/ <br /> CONTRACTOR NAME: <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: 0 OWNER 0 CONTRACTOR -MOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L4 <br /> tit\C-Ngk2 t 'r Clc-t2M CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Wor .$ on <br /> ) <br /> Proposed Use of Building: Heat Source: ❑Ga El Electric er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ISMAulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Atemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Pt .wit.ttsi�� ••. �-.�__.T <br /> ASSOCIATED BUILDING PERMIT#(if applicable) v / rq U\IJ� -) <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 Fi, ures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat* mp Toilet Bac ow Preventer(Inside Bldg) <br /> Forced Air Systems it Heater Bathtub Ual <br /> Gas Piping Boiler Lavatory(Wash Basin) Rrinking 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 - •okups Other: Clothes Washer Medical Gas <br /> Range H..=: Water Heater Other: <br /> Exha Fan Sink(Service/==r/Mop/etc.) Other: <br /> SPRINKLER/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 /> City of Everett Official Use Only <br /> PERMIT# <br /> (hrk.GC/4..24. 664--42.44*? 4//'The' (5 0 0 0 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />