Laserfiche WebLink
PERMIT APPLICATION <br /> /III -4 <br /> BUILDING / ECHANICAL I PLUMBING I <br /> SIGN /SPRINKLER/ DEMOLITION <br /> ' CITY OF EVERETT PERMIT SERVICES <br /> veilif <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 �°� thi <br /> PROJECT SITE ADDRESS: /OA J A( (q PL W EU C PROPERTY TAX#: con r� (il/d7t5 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: c6 c("2 h I1 P 11 -kTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /O 8 /ki (G`k. (>(... (.C) g4.)d IY�r?4.. a�U e Pt 11 vtJ STATE fi ZIP Os ' <br /> 1 <br /> CITY y/ <br /> OWNER PHONE: .' 3 -6,09 t,�C t 4, / OWNER EMAIL: T42.SeXaCk a.00...•Calf <br /> (�t <br /> CONTRACTOR NAME: IZ (I IL6rOl, ( �(vT2i rlk a" <br /> CONTRACTOR ADDRESS: STREET (-1'R(0 ,z4 0 ' -<- Si h /J /� <br /> CITY ? j k 0-0 t\ STATE ( /I 7�-j ZIP Q c`S (4iTh �t <br /> CONTRACTOR PHONE: 340`"N- & f' CONTRACTOR EMAIL:ejtQAjp(.,7Tjh etec...('P�IC°P (1.S' . re OM <br /> CONTRACTOR LICENSE#(REQUIRED): f)Q I I he i R t3 6R N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):_14 LB®4 <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: .,_(.._/, CONTACT PHONE: J7 (JdS-- 0,5-f: /-� <br /> .—IL, <br /> 1 (_r) CONTACT EMAIL: a_t^(lklf7TCJh f±Ik-L,lam-[v Aisn-. (1r'he <br /> BUILDING PERMIT APPLICATION ,.,. <br /> Existing Use of Building: S h- < Contract Price of Work:$1 f) <br /> Proposed Use of Building: Sr.(Z Heat Source: ❑Gas r ectric Other c("caiai 't;'1p.::: <br /> Building Type: ❑SFR-Detached rFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Additio Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION F WORK: I k6crkt.(- L(. s kw � c s S k`- t <15) Trek., ,.:3`0-0 W (114...0i-NO-etJ <br /> i- O ( 2tip1'Y\iL2a�Kveim►'ekS PrP C`_37,'J P Xtii <br /> ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT AfPLICC►TION ( PLUMBING PERMIT APPLICATION = <br /> Type of Project: _New — Addn Alteration Repair ` Type of Project: _New _Addn Alteration _Repair <br /> #of #df #ofList of Fixtures #of List of Fixtures <br /> List of Fixtures List of Fixtures Fixtures <br /> Fixtures 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 /> ,_r <br /> SPRINKLER I SUPPRESSION SYSTEM x ,. <br /> 'Chemical or Water I INo.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.Devi- "ons 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�+%party to•erform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> pity of Everett Official Use Only <br /> Owner/Authoriz gent gnature Date (Revised 9/23/2016) <br />