Laserfiche WebLink
� � <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 ADD ESS: �-v i✓ t� PROPERTY TAX ii RMI # � � <br />� _ ' �! - <br />� ,�i '.�V.Y' �l!��7.i, "Cr• . -'t-V'� �`i� i� �/� -'G�/ V � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER � � � � <br />� �,7 - � 7 Phone/E-mail � (� �,- � � ) � <br />Address ,� �� ,� � �;,� �.� ,- � ��� y �v � City/State/Zip �����r/�i � ,�� c� ��� G <br />APPLICANT: _ Owner _ Owner�S A92flt _ C011tf8CtOf _ COf1ff8CtOf�S Agent _ TeflBflf (must provide a letter of consent from the owner lo do work in the space) <br />CONTRACTOR �= ` � � � L � C, State Lic. # � � � � /��L `� ���/ City Bus. Lic. # c� � �� l il� � �� <br />�� �- f- /�% � _i <br />� �� �- � .�. > � �-�/� <br />Address � � ) > / � � � � � �, ' G r � % <:� Phone/Email � � � �� � � � � / � <br />�- G��1 �f <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />-� <br />������i;'� C �-� �,-�Z._, <br />Phone/E-mail ,;� �• - �, S �/- / " � 5 <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � i��" <br />� <br />Existing Use of Building ,:- � s-�� {r 4 t�«� ��t-�t. 7sr' �<C �?� «� HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric Other_ <br />Building type: _ Si gle�F , ily� Du _Townhouse _ Multi-Family _ Commercial <br />Type of project: Ne Addition Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />' �� c._- �� �� <br />��, <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 />; Gas piping <br />j Water heater <br />� Gas fireplace <br />i Gas range <br />Clothes dryer <br />Range hood <br />i Exhaust fan <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />Lavatorv (wash basin <br />Kitchen sink & disp� <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <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 tJae owner of lhis p�operty 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 />� y// ,,���� �r�/y �/��� /�.�___. <br />_" /.i�� y(i' .li�{�i,�� <br />QWner/Authorized'Agent ignature Date (Revised 3/2013) <br />