Laserfiche WebLink
Jul 17 2015 09:04AM All New Again 4254853333 page 2 <br /> • <br /> 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: PROPERTY TAX# P RMIIT V <br /> An <br /> LEGAL for new construction: Short Piat/subdivisicn Lot No. (attach copy of long legal dasoription) <br /> OWNER I r IQYI I e 'I 1 U Phone/E-mail y2.5 - 5s- 324b <br /> Address 3^1 2 f�.le� City/State/Zip �v�f�-�i Uu►� ` g 21�j- 4 915 <br /> APPLICANT: _Owner `Owner's Agen- JK Contractor _Contractor's Agent Tenant(must provide a letter of consent from the ownsrlo do rwrk in he cpac ) <br /> CONTRACTOR J})1 �Nt LO !yam Q Tn LL-C- State Lic.# 3-(2to ,TIS City Bus. Lic.# O <br /> Address 1540'B �nr t ;;6►') �1 # ( d�3 C`e2.k-- Phone/Email �SgB 85 333 3 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ^^��� 2 <br /> Phone/E-mail bnn 4-5. S3 0 , -7 b 1+3 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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 Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Now_Addn _Alteration_Repair Type of Project: _New_Addn -2w, Aft—tion Repair <br /> Show Number t! of fixtures Show Number # of fixtures <br /> A/C-air handling units I Toilet <br /> Forced airs stems I Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace t Kitchen sink&disposal <br /> Gas range l Dishwasher <br /> Clothes dryer 1 Clothes washer <br /> Range hood Water heater <br /> Exhaustfan Sink servicel6ar/mo etc. <br /> Heat um Backflow preventer <br /> Unit heater Urinal <br /> Boiler <br /> Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> Num f Heads Other- <br /> I hereby ceniry that I have read and xa ed this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be oompl <br /> with whether specified he in or no.Th granting of a pem4t does not presume to give authority to violate or cancel lho provision of any other state or local law regulating construction <br /> That I am authorized to th r property to perform the work forwhich application is made and t comply with the state Contractors Law 78.27 RCvv and 296.200A WAC. <br /> OwnerfAuthorized g n ig ature Date (Revised 9,/2014) <br />