Laserfiche WebLink
,fir PERMIT APPLICATION <br /> �'",, BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <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 Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1.5a , ity 1�j„,? c 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): TRA T2 <br /> OWNER MAILING ADDRESS: STREET U-uv.4 Y Pol`S <br /> CIN STATE ZIP <br /> OWNER PHONE: 1VIK Qi kaki OWNER EMAIL: <br /> CONTRACTOR NAME: a 36- Q r(Ar1/41 <br /> CONTRACTOR ADDRESS: STREET 57 SI 5 <br /> CITY41A((, Q^) STATE vs ZIP a 0 0 o I <br /> CONTRACTOR PHONE: , ), 2 275- CONTRACTOR EMAIL: 17p3 ( KAZIfyi ,c y‘o(tQ , CC <br /> CONTRACTOR LICENSE#(REQUIRED): }}C2N(g.3 g . S 0 j CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 Sd <br /> PRIMARY CONTACT: 0 OWNER I -CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 6- 2-2-7— 2.--7S— <br /> #0 <br /> .--0 06. Q CONTACT EMAIL: ,-k,syyj pekiN✓►r �n IAA C i Y•W <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ S-5-00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> C(�► 4V 4- -Ye tic -U Cir TrN Toc -. N OA k <br /> —/Z SYd rrat/,5 <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 Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 /> :-3 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 <br /> Everett Official Use Only <br /> 6.7g PE" ' #‘ lU <br /> L1lJ � v L <br /> Owner/Authorized Ageature Date (Revised 9/23/2016) <br />