Laserfiche WebLink
PERMIT APPLICATION 3 L 0 r <br /> trolVA. —A-- BUILDING/MECHANICAL/ PLUMBING/SIGN/SPRINKLER/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: 1,2/Lc f ! 41" SE tv t,,-f W 1 (a 4PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: cf4,4,0 (,,„,411 TENANT NAME(If Commercial): Sj,1„,11(,f,!r iq Pi-5 <br /> OWNER MAILING ADDRESS: STREET (,�/I.` /Cri lin 4(.1 �/ <br /> /j c G <br /> CITY ITC(� '- STATE ��r"1 ZIP � 0- <br /> OWNER PHONE: LL,2 J 33-7 5,,3'3 OWNER EMAIL: ).Iver(„ t',chi. f' f`t Ur"() 4 i I tik;'. / )141CONTRACTOR NAME: I J <br /> e-d <br /> CONTRACTOR ADDRESS: STREET J 3 ,9( 9 k7„-\ S+' /1 <br /> CITY t�/f1 Ji STATE Vft"T ZIP j rq 3 i I4 <br /> CONTRACTOR PHONE: 1. , CONTRACTOR EMAIL: SU <br /> ��7:`1 "" �����G 3`'t C.r.�—� r a� �,_-� ; )'x�zl". �r>i�"1 <br /> CONTRACTOR LICENSE#(REQUIRED): �s <br /> �_�}, e\` I� (, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): rjj <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTNAME: 5 y-, e.--ki- CONTACT PHONE: -'j -,:;--/S i-- /i ii/ <br /> CONTACT EMAIL: {{ r' e` ^� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 4(ID I5-bt') <br /> Proposed Use of Building: Heat Source: ❑Gas r .ctric ❑Other_ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: d ' ❑Commercial [Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p j u } t <br /> (1 <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 #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures <br /> NC—Air Handling Units Heat Pump j Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler 18 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove (,j Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting (a Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: b2, Clothes Washer Medical Gas <br /> Range Hood f, Water Heater ,, Other: (,se 83, <br /> Exhaust Fan Sink(Service/Bar/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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply <br /> .- h=ate Contractors - 18.27 RCW and 296.200 WAC. <br /> / /- Q /� J Q City of Everett Official Use Only <br /> �!�i ' V( l V IPERMIT# <br />