Laserfiche WebLink
To: Page 1 of 1 2015-04-20 16:53:26 (GMT) 14253281543 From: John Herzog <br />� � <br />PEf�MIT Ai�PLI�ATlC��! <br />�: BUILDING/MECHANI�AL/PLUMBlNG/�iGN/SPRINKLER/DEMOLITIQN <br />CITY OF EVERETT PERMtT SERV(CES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITEADDRESS: 12� ��� S! �( PROPERTYTAX# PERM[T#� �� � <br />� li <br />'` LEGAL for new construction: Short Plat/subdivision Lof No. (attach copy of long legal description) <br />OWNER ��� K-�r�l� S Phone/E-maii �ZS �2f ~ S�S� y� <br />ddress � 2% �( ��j 1 ,S F City/State/Zip �����/% L�T�- Q�� <br />" APPLICANT: _ Owner _ Owner's Agenf _ Contractor � CO(lYFBCtOf S A98f7S _ TBI18flt (must ptovide a letter of consant irom the owner lo do work in the spaCe) <br />CONTRACTOR ��2r / S' �jp�,� G State Lic. # F�,L,2 �O,��QL.L City Bua Lic. # <br />ddress `��' �, �'Dvj�-� �p,q.� yy�.viLlLiL�p �c.�.Q- '�2 %� Phone/Email �ZS �/5 —�S� JC <br />"; TENANT BUStNESS NAME CONTACT FOR PERMIT <br />Rhone/E-maii �����,,r3� �r1j f/ZlGR/Sl dPAD�i.c�G �� <br />�UILDING PERflIIIT QPPLICQTION CONTRACT PRICE QF WORK }� /G%i7b � <br />'i :Exisfing Use of Buiiding ��d�f HEAT SQURCE: <br />Praposed Use of Bui ing Gas Etectric Other <br />Building type: _ Singie Family _ Duplex _Townhouse _ Multi-Faniily _ Commerciai <br />T pe of ro ect: New Addition Remodel ✓fte air T.E. Si n S rinkier Demolition Chan e of Use <br />�ESCRIPTION UF W�RK (adciitiona! space provided on the back) : <br />��.G.hnaE.� ��c ( STr.-�f> Cc�✓�t,�os l i/r�ti.:s l/�4o�r.�+-' / /9yt-+;J r?f�G,�C} c� iTd�l J'��""-�. <br />'; MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />` Type of Project: _Nnw _Addn _Alteration _Repair Type of Prajecr _New _Addn _Alteration _Repair <br />Show Number (�I) of fixtures Show Number (#) of fixtu�es <br />A/C — air handlin units Toilet <br />Forced air s stems Bathtub <br />Gas ipin i Lavator wash basin <br />Water heater i Shower <br />Gas firepiace Kitchen sink & dis osaf <br />Gas ran e Dishwasher <br />Clothes d er Clothes washer <br />Ran e hood Water heater <br />Exhaust fan Sink service/bar/mo /etc. <br />Heat ump Backflow reventer inside bida <br />Unit heater Urinal <br />Boiler Drinkin Fountain <br />Refri erafion Floor drain <br />Woodstove Greass trap <br />Ductin Roof drains <br />i?' Other Medical Gas <br />SPRIPdKLER / SURPRESSION SYSTEM � Other: <br />Number o# Heads '� Other: <br />!'hereby certify thai I have read and examined this application and know the same to be true and correcf. Aliprovisions of laws and ordinances goveming this type oF work will be compl <br />'' ivrlh whether spec�ed herein or not. The granting of a permit dces not presume to gsve authonty to violafe or rancel the provision of any alher siate or local law rzgulatrng construction <br />Fhat I am authorized by the owne� of this properiy to perform !he work fo� which application is made and I compiy with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />��`�>� �-' �/��'a i� <br />wner/Auth zed Agenf S�gnaiure Date (Revised 4/2015) <br />