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.everettvia.org <br />�nvuncJJ: <br />rJ/l II '7 I / it PROPERTY TAX it PEsoRrdITC <br />b t10-025 <br />LEGA_ ""CwconsWction: Shod PlaUsubdivisfon Lot No.` <br />(attach copy of long legal description) <br />OWNER �% Se <br />Ph0ne1E-mail �-1 )J ) a S-J�q 13 <br />Address <br />CltyiSleie2ip <br />APPLICANT: _own,, —OwnersAgent _Contractor _ Contractors Agent _Tenon!fmvslpmldenenef cf oneen mm Monnv to mwenMV:a sPOu) <br />CONTRACTOR MUC✓, 1' 1,- h i n Stale Lic. ttMOC/N t'P�fl�TU <br />Ci Bus. Lin it053(o3S <br />Address 17SI > `/I �S� j_ / r,` 4,45 7(:V fr36U <br />S— SrT.o Jh Sr^ L✓ Ia 7j ZC1U PhonelEmail <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 <br />_ Gas_ Electric__ Other _ <br />Building type: _ Single,' rmily _ Duplex _Townhouse _ Multi -Family Commercial <br />^ <br />Type of Project:__ New _ Addition _ Remodel Repair T.I. __ Sign Sprinkler Demolition Chan a of Use <br />_ <br />DESCRIPTION OF WORK (adcaori space provided on me back) : <br />I <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Now _Addn _Alteration _Repair <br />Typo of Project: _Now_Addn _Altomilon <br />Show Number (k) of fixtures <br />_Repair <br />Show Number (n) of fixtures <br />r handlln^ imils <br />I Toilet <br />ir s s'.. <br />I Bathtub <br />ng <br />I Lavatory (wash basin) <br />aler <br />WIRange <br />Shower <br />lace <br />Kitchen sink & disposal <br />e <br />I Dishwasher <br />ryer <br />Clothes washerfan <br />ood_ <br />Water heater <br />_ <br />I Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat purno <br />I Backflow preventer <br />Unit heater <br />Urinal <br />I <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodslove <br />Grease trap <br />I <br />Ducling <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other. <br />Number of Heads <br />Other: <br />I hereby md3y Umf 1 Amn m+.d and cnmhM wm nppacatien orvl Iaow Iho same Io bo true ono mrmct Aa prwislaru of Imn aria anfine�e gommina this type of work wLI ee wmpam <br />wP.n weOMer OruGf/.M bervin or not The pOnl4g W a Penal aoea rim pmrvme W aNe anhwny b Notate of rAlufl Ne pfwblOrl of any IYJiCf SLtlO W IOml13w RQu1911ny COr45WPlen <br />Thai I am anhorked by the euner of this property to pWorm Vie xsatr for xfllcn appa.von is made and 1 comply, wth the Stele Contractors Law 18.27 RC W and 29B 20DA WAC. <br />S-�- 2 S-/r� <br />OwnadAuthorizod Agent Signature Date <br />(Revised ?R0f3) <br />