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: A , <br />© f' mXileX <br />PROPERTY TAX # <br />PE MIT # <br />tLtd ®0 <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />OWNER ,9M A e- � �� <br />Phone/E-mail � �� " f� �% ah�-/gC�' <br />Address l Z L,4S— ( Ave /iJ <br />City/State/Zip <br />APPLICANT: 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 p W <br />State Lic. # City Bus. Lic. # <br />Address <br />Phone/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />HEAT SOURCE: <br />Proposed Use of Building %' %S <br />Gas_ Electric r/ Other_ <br />Building type: Single Family Townhouse_ <br />Multi -Family <br />_Duplex <br />Type of project: _New _ Addition Remodel _Repair <br />—Commercial <br />_ T.I. _ Sign _Sprinkler _Demolition _Cha ge of Use <br />DESCRIPTIO F WORK (additional space provided on the back) : �� ���� jt/ <����-Z ,le�l5 /dv <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Type of Project: _New_Addn Iteration Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced air systems <br />Bathtub - <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Gas fireplace <br />j Kitchen sink & disposal <br />Gas range <br />( Dishwasher <br />Clothes dryer <br />j Clothes washer <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />j Urinal <br />1 Boiler <br />Drinking Fountain <br />Refrigeration <br />j Floor drain <br />Woodstove <br />i Grease trap <br />Ducting <br />Roof drains <br />Other <br />j Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />j Other: <br />Number of Heads <br />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. The granting of 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 authorized by the owner of this pro to erform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />'V9ner/AuthorizedApdt Signature Date (Revised 312013) <br />