Laserfiche WebLink
• <br />PERMIT APPLICATION <br />BUILDIt�G/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />E ADDRESS: � PROPERJY TAX # PFRMIT +k , <br />! ? C, �, �, i- S �- � �c� F_ - v` � �' =C- � � � � Z � � �;Ci C z� � l � I �-1��i Y ���i% -�� � <br />.iAL for new construction Short Plat/subdivision Lot No. (attach copy of long legal description) <br />INER K �� ?> i— r�, �L:� � C! 1 l� �..� C�- Phone/E-mail ���: Sf i.7� (�,z��`', <br />res5 ; �6� .�J:,�.� �,.:> ) � ` City/State/Zip �-'�< C-K= `i`1 , �.i,�'I! <br />�LICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�5 Ag@flt _ TBflBflt (must provide a letler of consent from the owner to do work in the space) <br />NTRACTOR �'�j�l.�� L:.`C�tt� ��tS�C rj�1i�G1L&ILic.#��'�"� ��'v����%�Z-sCO�Bus.Lic.#�'S���S <br />c. �,� t�� 1 � �. L;� 7 � ,, . . <br />ress �y� � �l� �1.. �� �� C�{ 1 �{ �.L, `� �� ��� Phone/Email `��-' �% <br />JANT BUSINESS NAME CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />PRICE OF WORK '�` !�� , i � ` <br />Existing Use of Building `� `�'� HEAT SOURCE: <br />Proposed Use of Building �1 �� Gas Electric_ � <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New _ Addition � Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (addition�l space provided on the back) : <br />� � � �� ��� <br />� .= '� Gi � . .' "� ':. � � �.. �.. � •_.� � �.. '�, z: � � 5. % <br />��,1 , �_.. � � 1 <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />y Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />I � Gas fireplace <br />Exhaust <br />Unit heater <br />Boiler <br />stove <br />j Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteratian _Repair <br />Show Number (#) of fixtures <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <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 applical;on antl know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />wilh whether specified herein or not. The granting of a permit does not presume to give authorily lo violate or cancel the provision of any other state or local law regulating construction <br />F <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296.200A WAC. <br />��i � `i]� ,� <br />t 7/ }� (� <br />.pl/' �_L'+-�~` `L � � �i ' � _ J � <br />Owner/Authori�ed Agent Signature Date (Revised 6/2012) 1�� <br />