Laserfiche WebLink
IIII''II PERMIT APPLICATIOIAli <br /> "` BUILDING I MECHANICAL/ PLUMBING /SIGN INKLER/ DEMOLITION <br /> All,� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6 OZ e''CJr`f,-K-- 1(1(LU JVC( I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): floor+ O J)I <br /> OWNER MAILING ADDRESS: STREET 2? 3 La ke,Pc a-/2 Of ke / Su,(te 400 /� <br /> /� )CITY 'nr <br /> 3 ,,r4 r i STATE *p/ ii ZIP , 6O[ j <br /> OWNER PHONE: 1.01- 47 1 •-)(.42,j-t OWNER EMAIL: '7-La ie, • Sick rLy n3 yrs-I fthor/and dm, In ,&' <br /> CONTRACTOR NAME: `--._ ( 0 <br /> CONTRACTOR ADDRESS: STREET J�3 S ��k f. ) e /� ���y <br /> CITY <Ccv 1-0 O STATE (V. O !.} lZIP tS <br /> CONTRACTOR PHONE: Cel 3c TRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(R ED): b(�e,..0.t,Cj$ Titria OF EVERETT BUSINESS LICENSE#(REQUIRED) S -1 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR KTHER(Please Specify) <br /> CONTACT NAME: ago �^ CONTACT PHONE: 3, d3.-Ing -(a' 75`" <br /> 5-Lac&1 H /J ern CONTACT EMAIL: S! rL Ofeysbyi e e _forpOI o`'`1s•o,a <br /> BUILDING PERMIT APPLICATION <br /> DO <br /> Existing Use of Building: ,Ina )S i re. Contract Price of Work: $ f I • --- ----•Proposed Use of Building: ic_11))-f' - o 4- O{fC� Heat Source: as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New DAddition emodel CI Repair ❑T.I. ❑Sign ❑Sprinkler , Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: • <br /> - <br /> Exfe,voy mocit hca„tion moi C11iol moect i 04SktiV-M6-6 )3 <br /> Z . NAV C) uri4e9nsor. <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 Rep <br /> #of List of Fixtures #of List of F' res #° List of Fixtures #°f Li Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 11 NC- ' Handling Units Pump 5 Toilet low Preventer(Inside Bldg) <br /> Forced Air ms Unit Heater Bathtub Urinal <br /> l' Gas Piping Boiler I Lavatory(Wash Bas 7 Drinking Fountain <br /> I Water Heater Refrigeration Shower `2i Floor Drain <br /> Gas Fireplace ood Stove _ Kitchen Sink : .Isposal Grease Trap <br /> Gas Range` Duc - Dishwa .-r 'i- =c.f Drains <br /> Clothe ryerHookups Other: CI. es Washer Medic. -s <br /> R. .e Hood 4.14 i <br /> f ater Heater Other: <br /> A xhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> P SPRINKLER/SUPPRESSION SYSTEM, <br /> Che 'c or er gC <br /> U ' I" o s <br /> A KNOWWLE EMENT: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 /> i ( , City of Everett Official Use Only <br /> .�1/�J, f ' 4,0 t I 0 PERMIT 6 VO o112.) <br /> l ;/ ; <br /> Owne 'thorized A e t Si natur: / Da (Revised 9/23/2016) ` <br />