Laserfiche WebLink
tERMIT APPLICATIO <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: PROPERTY TAX# PERLIVVIIT# <br /> / `-t C 2 SE ruazro y- MAL!_ LU x\--,/ l 1 CJS:5 - 00 t` <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> r d <br /> OWNER f C 4c. C‘(��-eu ,4Q, Phone/E-mail <br /> Address � O 2– S F Tv6- T T MALL GL,A)/ 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 17. yQ U 1.1.G�5 Pt-LA -'t a t r t L, State Lic.#'Dy()U.Il.1.y PC17(o PO City Bus. Lic.# 410 <br /> yi n3�( _ �t2 1 1(e ,�IS <br /> Address L 6±7... j�.F- )2L-f -" e <br /> S Trelct- ow,Qv it f(� Phone/Email&o2S 8,. . ooce <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT /� <br /> -TVeaFrr 4-C. A+—C) dw�NC R Phone/E-mail 0L:ale1<�-DyciN.6 s . CO AL"? <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK :21'300 ° <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: —Single Family _Duplex Townhouse _Multi-Family _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): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New^Addn _Alteration_Repair Type of Project: New Addn X Alteration,_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—air handling units I Toilet <br /> Forced air systems I Bathtub <br /> Gas piping 1 • ! Lavatory(wash basin) <br /> I Water heater I 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(inside bldg) <br /> Unit heater I Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> Ducting I Roof drains ' <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby)certif"yithat 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 wh ttier,-specified erein or ot.The gra ting 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 /> fihat I a horized the own r of th's pr erty 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 /> 7---' �-- 51il1s <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />