Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: ' . '4,g 7 I5 Rex;k�Ih ,PR #OPERTY TAX PERMIT <br /> '514101 -004-/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ,'t IV*. (W(..„(J_i Phone/E-mail 2.-406 S l) Z-5 Yr, <br /> Address (POMC Milk kl)( pie i L) City/State/Zip A1/4Q,s' viC.CK/ aJdg- ./Oz'7/ <br /> APPLICANT: X Owner _Owner's Agent _Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 40(c- State Lic.# ,(XSC:UC q lC 0 ( City Bus. Lic. # <br /> Address (gbh AA14424 Ag, DTE k Phone/Email 7_C6 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> GvenRu,2,.0 G G r <br /> Phone/E-mail .441,412fr=fe() - CGI% /i2(l Gf_/:CC/l4 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building OW( HEAT SOURCE: <br /> Proposed Use of Building 6 f4iVk o Gas Electrt Other <br /> Building type: Single Family Duplex Townhouse Multi-Family X Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): R pIC)'✓� EX/571 J 6 G- /G 647-C—) S �. <br /> RiS7611- SMW L0A-4--, /4-7-4/J PP-C 06 < (6 ) , (iCW <br /> PP-O 1 C-TieU cF �o� ,t <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping j Lavatory (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range I Dishwasher _ <br /> Clothes dryer j Clothes washer <br /> Range hood Water heater <br /> Exhaust fan r Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer _ <br /> Unit heater j Urinal <br /> Boiler j Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.Th ranting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorize. •:the ow r of is property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / . <br /> i a ��/ <br /> / <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />