Laserfiche WebLink
ys � <br />�a �� �002/OC3 <br /> ',r. 0./^C/�01= TUS f�: 55 PAX _. _ . . "__.___. <br /> '_._ _._ _. .-__ __-___._. <br /> ___—.__..__—__ ..____.. <br /> .t,-'.... . <br />=��" PERMIT APPLICATION <br />�y ^ BUII_DING/MECHANICAL/PLUMBING/SIGN/SPRIPdKLER/DEMOLITION <br /> d` �.� ,. a u -I Z <br />�'�s:;;: CITY OF EVERETT PERMIT SERVICES <br />���` ' 3200 Cedar St., Fverett, WA 98201 -425-257-8810— PAX 425-257-8557—www.everett�va.ug <br />''�"� � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS: PROPERTV TAX N ERMIT 7! <br /> • ��5t # 1207.. q�t� o��zozod - 3 <br /> � � LEGAL for new wnslruclion�. Shcn Plat/subdivlsion Lot No._ (attach copy of Ung Icgal descnp;ion) <br /> ' OWNER {,.,•11� {� L a G � Phone/E-mall y25� � Z��'1 <br /> Adtlress � g - �j 7`� J� T� 1Z�z- City/Stale/Zip Ve,Y'e.Ti {�. � �Z�� <br /> CONTRACTOR (71'+C t4 L 8 I Lic.# V� T <br /> Address �y S . �-�µ �_Qa.j� Pt�one/Email �.��,p $� � p l � <br /> . TENANT BUSINE55 NAME CONTACT FOR PE�MIT <br /> � Phcr.=/E-mail �e�sse. •{+��+��� � <br /> BUILDING PERMIT APPLICATION CONTRACT PR�CE OF WORK ?��-�'O _ <br /> , �� Existing Use of Building s�� Hh1ff SOURCE: <br /> , Proposed Use of 8uilding Gas� Electrm_ Olner_ <br /> ' Building rype: _Singte Family _Duptex_Townhouse .�MWti-Family _Commerclal <br /> Type of project: _New _Addition _Remodel _Repair_T.L_Sign_Sprinkler_Demolition_Change of Use <br /> � DeSC�iption Of�Work(additiona!space provrd d on the backJ: p���g� <br /> �r�si�ttl�rep(ace �as -�u.rnctCp� ►�e.v�nox S�28UUH��v3c,es�� �- <br /> �bdlo , I lcsz �Cvr l�� • <br /> Havo you s[artod working without a permit7 _YES X NO <br /> MECHANICQ,L PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypo ot ProJecC _New_Adtln �Alleratlon_Ropalr 7ypo of ProJecl: _New_Atltln _Alteralion_Repalr <br /> . Show Nmnbcr(#)offlxfures ShowNumber(#1 ollix(ores <br /> A/C-air handlin units 7oilet <br /> � Forced air s stems Bathlub <br /> Gas ipin� Lavatorv(wash b2sin <br /> Water heater � Shower <br /> Gas fire lace Kitchen sink 3 disposal <br /> Gas ranqe Dishwasher <br /> Clothes d ar Clothes washer <br /> Ran e yood Water heater <br /> �� Exhaust fan Sink(servicelbaUmop/elc. <br /> Heat um I Backflow preventar <br /> Unil heater Urinal <br /> • Boiler Unnking Faunt�in <br /> � � Refrigeration Floordrein <br /> Woodstove Grease trap <br /> I : Ductin Roof dreins <br /> Other_ Medical Gas <br /> "' SPRINKLER/SUPi�RESSION SYSTEM Other <br /> Number of Heads Other: <br /> 1 hereby certdy that I have read and examinetl Ihis applicaUon antl know the same to be Uvo and carrect.All pmNskns of laws and ordinances fl�veming <br /> this rype�t work will be complietl wilh whother soeclfied herein or not.The granting of a Fermit does not presume ro giva authorif y to violate or wncel <br /> tiie provislon of any other state er local law requlating wnstructlon or lhe pertortnance ol consLuction.That 1 am aulhorized�y the owner of Ihis properry <br /> lo pertor i the wo k for w�ich applicalion Is matle and I compy with the State Contractors Law 18.27 RCW antl 296.200 WAC <br /> �l /Z <br /> Ow dAuthodzy AgentSignaturo � ate (Revisad7/2o77J <br />, <br />