Laserfiche WebLink
PERMIT APPLICATIOR <br /> �+--� BUILDING I MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> 4111 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: ( Z 7 2 g fu$Ct f-/ivy 5(4 4-. (A( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: or rnA,(. 5 71;v,e^S TENANT NAME(If Commercial): la y z.e, <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'IX{ JP v bSon. Co <br /> CONTRACTOR ADDRESS: STREET 575 3/ NL- /4'0 (� <br /> CITY ki/14-`,� STATE / ye ZIP 7 6 03 g <br /> CONTRACTOR PHONE: YZS- SQ/-9g 3 CONTRACTOR EMAIL: jet 414-.0 it e rob 5o".co- cowl. <br /> CONTRACTOR LICENSE#(REQUIRED): gv630*.A-b S 5 4 A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):* IZf,1J <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 9 Z S'- 59/ - P9,S 3 <br /> Kv1SO CONTACT EMAIL: r`a 54,n 0 IL re)65at-icED-Coves <br /> BUILDING PERMIT APPLICTION <br /> Existing Use of Building: Contract Price of Work:$ l 0 i b . <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CT.]. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> UI'lr►t1wI v CA1IiiC✓ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 0 17(A,-6 q <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 Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Z, Toilet Z. Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler ( i,. 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 /0 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 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 /> 3 �� �1 !l/7d g PERMI I 0 6 pc, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />