Laserfiche WebLink
PERMIT'APPLICATION <br /> BUILDING 1 MECHANICAL 1 PLUMBING I SIGN I SPRINKLER I DEMOLITION • <br /> . city OF EVERETT PERMIT SERVICES <br /> T 3200 CEDAR STREET,EVERETT,WA 98201 . <br /> (P)426-257-8810 I FAX 426-257-8857 1(E)everetteps@everettwa.gov 1 miww.everettwa.gov/permits . <br /> (blue'®e'131ai k Mk a.riklpli ps) • : IPRO Jl (t9` Wt 11iN 0.0111Mrie i . _ • <br /> i <br /> C9PROJECTSITEADDRESS: /Q-30L(..4 5/ JtKL <br /> ' /1/4-0 PROPERTY TAX#: I <br /> LEGAL for new construction: Short Piatlsubdivistort _ Lot No. (attach copy of long legal description) <br /> . . CONTACT INE®R,i1111MT1®E . ' . .. • • • •• . . . .• <br /> OWNER NAME: DAV- fax TENANT%7NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET t t+30 ) (•Js4-6 A.,0 /CS._" �J� • <br /> cliY / r.--Vi SIATE LA ZIP qG'�J <br /> 'OWNER PHON � /! -.._•.........m..,,s. .OWNER EMAIL:... ..N. .., .....ti. .. ....._ .. .. . . <br /> CONTRACTOR NAME: E UC P AJ 6`t- -T?( :"iC mg-r-firc. <br /> CONTRACTOR ADDRESS: STREET °7-I 2,0 (-eAk.l AO g. <br /> ITY EURIrri STATE WA— zip 6M26( <br /> CONTRACTOR PHONE: 4'2,5-2 5 2.-31 1 4 • 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): E(JE .ej,®2.to r CITY OF EVERETTBUSINESS LICENSE#(REQUIRED): 06 r - $-• <br /> PRIMARY CONTACT: El OWNER 1:E.CONTRACTOR Ei OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 475 2-5-2--,//9 <br /> g4 ,r,CONTACT EMAIL: - <br /> Existing Use of Building: i Contract Price of Work:$ % VV g 1 <br /> Proposed Use of Building: Heat Source: I Gas ElElectric ❑Other <br /> Building Type: gSFR-Detached OSFR-Attached CIDuplex C]Muitl-Family-#of Units: ❑Commercial dindusfriai <br /> Type of Project: ElNew ElAdditlon EiRemodel Repair DY.i. CJStgn DSprinkler ClDemolitlon ElChange of Use <br /> DESCRIPTION OF WORK: Kept C4 {-- _`2 , <br /> ASSOCIATED BUILDING PERMIT#(if a.pilcable): <br /> fV1Ebd-MR1!(Csi ,,Ol RM1T liipuC i k . ' • . PLUM�1 a Pla9RI1IIUr,s�PPILl1CATIO I <br /> Type of Project: New__, Addn Alterati• �.,'epair I Type of Protect: _New ^Addn Alferaffon Repair <br /> °f List of Fixtures I #°{ List of Fixtures 1 #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> g) <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 <br /> Other: Clothes Washer Medical Gas <br /> Range Hood Wafer Heater Other: • <br /> 1 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> .'SP RBSTnEl /.,IJPPi e.` i©Ri SYSTEM i <br /> Number of Heads <br /> t CKNOWLEDGEMENT•/have reviewed this application and confirm the information contained herein Is true and correct.Work done pursuant to this permit must comply with <br /> :urrent federal,state,end 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 /> Wilding Official before being authorized under any circumstance I am the owner,or!am authorized by the owner of this property to perform the work for which application Is made, <br /> act I comply with the State Contractors Law 18.27RCW and 296.200A WAG <br /> - ' <br /> C/ti of Everett Off/c/el Use Only <br /> PERMI <br /> /--194P C I , <br /> — <br /> Amer/Authoriz _103 <br /> d Agent Signature Date (Revised 5/20/2016) <br /> f <br />