Laserfiche WebLink
PERMIT APPLICATIolI <br /> ellPHiv;.-.4- BUILDING I MECHANICAL/PLUMBING I SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (13).425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpe s <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION ,n,,.'�'f ' 9- 08- <br /> PROJECT SITE ADDRESS: Wu 191 lvt $ Evntit 1 IA)j `ilx0% PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A v it.,IAn 6 NI TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (a()¶ jr:1Ave. SE <br /> CITY Eve rcft.' " STATE OA ZIP ,gp?O$ <br /> OWNER PHONE: 1-/ 37— 5/0/..r3 OWNER EMAIL: Sf ivel k keunG,.!' 0 Tel I`STa .cc,orl <br /> CONTRACTOR NAME: $'qc Lk-LTV <br /> CONTRACTOR ADDRESS: STREET 611 11 P41.j Lla/1 S f <br /> CITY 4 1P40.441;,4 STATE u A _ ZIP r2tx.3t 4 <br /> CONTRACTOR PHONE: '1 p 3✓q(,I-03 yyj CONTRACTOR EMAIL: Sear; r( 5q?oaf('• (o,7i <br /> .ONTRACTOR LICENSE#(REQUIRED): joL v44.8, S `J2 t,----- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) S"8S3 8 <br /> CONTACT NAME: 511201/ GCr-Pt f CONTACT PHONE: 703_,)8 f- 1‘,.,i <br /> CONTACT EMAIL: SLGI,"kre 5,5,„4J-,4),,Ir1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: — 'Contract Price of Work:$^ 4 glaPear2 4 Z' °u° <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex 'Multi-Family-#of Units: Cl Commercial ❑lndustrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Wepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �epKlee pill 5o-fele pvidole cele I..,es cap. p <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fi uresFixtures <br /> A/C—Air Handling Units Heat Pump `"l Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Ly Lavatory(Wash Basin) Drinking Fountain <br /> • <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove i 91, Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting l O Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. 141 Clothes Washer _ f Medical Gag _ <br /> Range Hood i Water Heater <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. - <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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.lam 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 ate Contractors Law 18.27 RCW and 296.200A WAC. <br /> ,...--illiprocalb <br /> City of Everett Official Use Only <br /> � � ! PERMIT //a/00f%fifer/Aut'u iz:!men Tgn.ure 'at= (Revised 9/23/201`6) <br />