Laserfiche WebLink
ji PERMIT APPLICA <br /> BUILDING I MECHANICAL I PLUM I:ING /SIGN I SPRINKLER I DEMOLITION <br /> 4000/-4 <br /> 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 ,sack Ink Only Pieas�) P ., SECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: f / ( t� � j, r` PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION • <br /> Id ,(4,,,,,_, <br /> OWNER NAME: ! TENANT NAME �(If Commercial): rfa ~" <br /> OWNER MAILING ADDRESS: STREET /107 6.9'e e ti1 • <br /> f qTY eA/(f/ reel STATE �'v/ �' ZIP / ,Z, <br /> OWNER PHONE: L���j s� �� 777 OWNER EMAIL: . - y , , l<L ,, i( ' <br /> CONTRACTOR NAME: Foga: 6--,,,74,,,,,,,"--.7(� tJ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> • <br /> CONT NAME: CONTACT PHONE: ,{ <br /> g ?® CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 1 61.--114/44,,keel se w Contract Price of Work:$ •at 06,1/ <br /> Proposed Use of Building: 9A//41,- <br /> Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 71.Commercial :• •ustrial <br /> Type of Project: ❑New DAddition DRemodel ❑Rep air 'TTA .1. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: d <br /> — <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 06Z `y '" <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 #of #of <br /> List of Fixtures List of Fixtures --.,, List of Fixtures List of Fixtures <br /> Fixtures Fixtures tures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside BIdg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavjatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Sh wer Floor Drain <br /> Gas Fireplace Wood Stove ' then Sink&Disposal Grease Trap <br /> Gas Range Ducting ishwasher 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 comp) .'Th-the-atate Cvntraeteislaw 27 RCW and 296.200A WAC. <br /> , `�18. City of Everett Official Use Only <br /> /'e <br /> Air ____ ��/ PER a 5 �6(5 <br /> ag- D to (Revised <br /> OwnerlAuthorized Agent Signature 9/23/2016) <br />