Laserfiche WebLink
������ ���Q������ <br />��I�,�I����������������.��������I��������:����������,����� <br />CITY OF EVERETT PERIVIIT' SERVICES <br />3200 Cedar St., �verett, WA 982�1 425-257-8810 FAX 425-257-8857 www.everettwa.o�g <br />PROPERTY TAX #i <br /># <br />� L`l� 1 ��1Mf'lJ,� rkl/� • I �����}'�� <br />for new constrUction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />�� ; �� � � �� PhonelE-mail ��iY i� - ��, " �� � � <br />�r <br />Owner> Owner's Agent _ Contractor _ Contractor�s AgBf$ _ TeflOflt (must proyida a leller of consent from the owner to dp work In the space <br />CONTRACTOR <br />BUII.DING PERMIT APPLICATI <br />Existing Use of Bullding � t"-� ' <br />Proposed Use of Building "� f <br />Building type: ,_ Single Family _ Duplex _T nhouse _ h <br />Type of project: _ New _ Addition _ Remodel _ Repair _ <br />DESCRIPTION OF WORK (additional space provided on the 6ack) : <br />i� ��. �i , (�� � � � [� i w ,�� <br />'w� � � ti. c�` <br />ofProje�t: _New_Addn _Alteration_Repair <br />Show Number (#) offixtures <br />A/C — air handlinq units <br />Gas <br />uas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeration <br />SPRINI�CL.ER / SIJPE'RES�IOM SY�i'EM <br />Number of Heads <br />Lic, # <br />Phone/Email <br />�-v .� L{ 3� � �'i l 1 <br />=-mail <br />� <br />T.I. <br />Citv Bus, Lic. # <br />PRICE OF WORK � I �D��`-� <br />_ Commercial <br />HEAT SOURCE: <br />Change of Use <br />� �" <br />/(/`�-<-' �' �--- �� � � '\ �"1�`1' cJ � <br />� <br />ING PERMIT <br />Type of Project: ^New _Addn ,_,Alteration ._Repair <br />Show Number (#) of frxtures <br />� l'oilet <br />�� <br />Kitcnen sintc rx aisposai <br />Dishwasher � <br />Clothes washer � <br />Water heater <br />Sink (service/bar/mop/etc., <br />Backflow preventer (inside <br />Urinal <br />Drinkinq Fountain <br />vrease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other, <br />I hereby certify ihat I have read and examined this appllcation and know the same io he true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein r not. The grantin9 of a permit does not presume to give authority io violate or cancel ihe provision of any other staie or local law regulating consiruction <br />Thaf I am authorized by the o er o o t ie work for which application is made and I comply with the Siate Contractors Law 1a.27 RCW and 296.200A WAC. <br />� <br />� Z�' �� <br />Owner/Authorized Age t S'gnature Dat (Revised 4/2015) <br />\f � <br />