Laserfiche WebLink
4ON <br /> *PERMIT 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: f ✓ j >� PROPERTY TAX# PE MIT <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) () <br /> OWNER 4 i1 SA At 0 4n Phone/E-mail <br /> Address -5'.- 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 State Lic.#C,• rirAIC f /0' A3 City Bus. Lic.# <br /> Address 0/65y fpr ,mac Phone/Email <br /> TENANT BUSINESS NAME V CONTACT FOR PERMIT' / Fr-�.G <br /> Io A r C �s�%L° Phone/E-mail ,+�f �2Wit' 3 u r0 CC' <br /> BUILDING PERMIT PPLICATION ICONTRACT PRICE OF WO K G' /re�,) <br /> Existing Use of BuildingC- HEAT SOURCE: <br /> Proposed Use of Building 5--,"1 z 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_Demo]ition_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 ,_,Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C–air handling units I Toilet <br /> Forced air systems I Bathtub <br /> Gas piping Lavatory(wash basin) <br /> 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 Urinal <br /> Boiler Drinking Fountain <br /> I Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> 1 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 complied <br /> wi 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 /> T a I am authorized by the ownr of is property 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 /> O ner/A ed Agent ign u Date (Revised 4/2015) <br /> t <br /> 12- <br /> 1 <br />