Laserfiche WebLink
0 <br />• <br />PERMIT APPLICATION <br />BUILDING/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 />ITE ADDRESS: �� ;�1 .1 i� {� f�� V� E � v;'��`�3 ,� � PROPERTY TAX # F��"1��llp� j I OZ-2'�`� P MIT <br />�7� � f 'Q`�y3`I16710�1��� ��? �7_-���7 �n <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />� <br />OWNER '� � �., �,� � t' Phone/E-mail �'I Z 1 � � " �, <br />Address �I�.�1�s '�j �' L' � - L . City/State/Zip , �P�l;� �� - C``�� '�i�' <br />APPLICANT: ,,�Owner _ Owner's Agent _ Contractor _ Contractor's Agent �Te(18f1t (must provide a Ietter of consent 6om the owner to do work in tha space) <br />��x>S � �i � IJ-1 <br />�,�►<� � L�� C_ �� � � r � <br />BUILDING PERMIT APPLICATION <br />L& I Lic. # U�jU ��" COE Bus. Lic. # <br />�I -�-�� <br />� �u % Phone/Email -�i� h/► � <br />C NTACT FOR PERMIT 1� <br />.,=�u�iQ.'�J��a���IS�Q,�O�C�1s- C-J���`� <br />Phone/E-mail <br />TRACT PRICE OF WORK �SU� ) - � <br />Existing Use of Building �� � 1�1'e1� HEAT SOURCE: <br />Proposed Use of Building �!�cv�t Gas_ Electric Other_ <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 />DESCRIPTIC?N OF WORK (additional space provided on the back) :� LJS G p�� � n�" Z vV tSZ' yy/� j, ��( � s <br />� ;� � r�D� � �oop_ � TN�: ,'�:�Y'-TI� ��ll. .qS � �� tX� T:, �l/�1,�-S A1?L No►�/ <br />F3�r�p�Nb �'_�"�( lt� �AYL� �T�t� �VT��- j-�ALL�N/�� ,,�►� ��JVTS 1Qt' .-�Plzl N�e�f=- S•�s i�^^ <br />t� � ti' :.�Y,�-..�5 yv �!�� `�P�!�% o�zv�J� t� ��o t-1./��� �-� 7- r, �° L-�� TS -. <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixfures <br />A/C - air handling units <br />Forced air systems <br />Gas pipinp <br />vvaterneater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Exhaust fan <br />Unit h <br />Boiler <br />� Woodstove <br />% � Ducting <br />i Other <br />SPRINKLER / SUPPRESSION SYST <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repai r <br />Show Number (#) of fixfures � <br />Toilet <br />Bathtub <br />Shower <br />Kitchen sink <br />Clothes washer <br />Watei'heater <br />Sink (service/bar/mo <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 lhis application and know ihe saine lo be true and correct. All provisions of laws and ordinances goveming this type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume lo give authority to violate or cancel the provision of any other state or local law regulating consiruction <br />That I am authorized by the owner of this property to perform the w k for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�/�.���-=�� � <br />�.//,� , �z <br />OwnerlAuthorized Agent Signature Date 1 .�-._ ��. (Revised 6/2012) <br />