Laserfiche WebLink
41/ERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES j <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> L-100 Itin f <br /> SITE ADDRESS: PROPERTY TAX# P RMIT# <br /> 2y �GLL:z--b :I c;l: i�JD�I 'Ol5 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> cal <br /> OWNER � ( ort-4 <br /> �(�,� 4) � Phone/E-mail �/q�/� <br /> Address //h? Rtr(f 1 L /1L, City/State/Zip tt' KJT ) (,t%��� L 7 <br /> APPLICANT:Ii Owner 11 Owner's Agent Contractor U Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR i..VermalisfyiNAP State Lic.# /4E p I1-CL Bus.Lic.#0 j3Z(oZ <br /> Address 7.Z-� �d ! �I G 10 V.441 / ��, � Phone/Eman 04 CA.Y1!/�501\.)SGV <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT fCG��ran �c�^, <br /> 2i. 2.ao"1-5soI 1aY1 � <br /> Phone/E-mail'Tiadoptti,:oJ( Z ver a r►SDn , U.)#11 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 1.\f'.4t•%--`,t-{ HEAT SOURCE: <br /> Proposed Use of Building Gasj Electric❑ Other El <br /> Building type: ❑Single Family a Du lex❑_Townhouse . Multi-Family 12Commercial <br /> Type of project: n New nAddition II Remodel Ft RepairupT.l.n Sign nSprinklerrlDemolition❑Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ' n -\-6 kNiv-,q,. -two KIA .) v(- S/r)k-S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:LINewuAddn LIAlteration Lepair Type of Project:1i New❑Addn n Alteration EIRepair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping 2 Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler 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 comp <br /> with whether specified herein or not.The granting 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 authorized by the owner of this property to perform the work for whi h application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> IN , Cj r <br /> 7a5 .0) 5 <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />