Laserfiche WebLink
• <br />� J <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 />TE ADDRESS: , <br />ig'2i vy� <br />LEGAL for new construction: Short PlaUsubdivision <br />OWNER j�i.N'Jln �i��ie�l !tt ✓O�Gc�i% C/ �iv� / +"! <br />Address Z � �t f ✓ �C> � �%�i' W <br />PROPERTY TAX q <br />o�y3.��33�o I <br />RMIT # <br />Lot No. (attach copy of long legal description) <br />PhoneJE-mail �p6 -33Y.- �i,�jL/ / <br />City/State/Zip �•�itn��l/,4�1/,�V �. /�If,� ���J': <br />� <br />APPLICANT: _ Owner � Owner's Agent _ Contractor _ Contractor'S A9ef7Y _ T0f18f1i (must provide a letter oi consent from the owner to do work in the space) <br />ONTRACTOR <br />NAM <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />��>�..-��Y�-�u�'`l <br />PRICE OF WORK �; � (����:� • 1 <br />Bus. Lic. # <br />ExistingUseofBuilding ���Sj�I��ZYL'i�'���- ,FLldf���'t,/✓"`=�(��`� HEATSOURCE: <br />Proposed Use of Building �i.vw¢. Gas� Electric� Other_ <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of projecY New Addition �Remodel !� Repair T.I. Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORKr (additional space provided on the back) : / <br />���'t� O�ie. ``i1'U,ar�� GC��ir�ed--T�ie �ie flUUd'_ C�,otiw°�J� JGi)��l'1 Lfb /�f�¢ <br />11�-e �e ���.�r�c�M �'���Y 1 ��Sd�u � �✓'e,,� �ti���r��.r f����`s� ISiS%i,.�c�s�r�wc��-�'�(�r�— ��' <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />i Forced air systems <br />i Gas piping <br />` ; Water heater <br />j � Gas fireplace <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />j Other <br />SPRINKLER / �UPPRESSION <br />Number of Heads <br />TEM <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration �Repair <br />Show Number (#) ef fixtures <br />;Z j Toilet <br />� i Bathtub <br />',� � Lavatory (wash basin) <br />j Shower <br />� I Kitchen sink & disposal <br />� i Dishwasher <br />� ; Clothes washer <br />�. - Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />; Floor drain <br />Grease trap <br />Medical Gas <br />Other: <br />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 />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 pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. � <br />/ / ty <br />=�"��-�,� l�-ly-- l� <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />