Laserfiche WebLink
• � <br />PERMIT APPLICATION <br />BUILDI�IG/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 ADDRESS: ��L��� - � r•� // /�I I,� IPROPERTY TAX N I PF�R.M� ���� <br />�" ft�� 1� �' C�L <br />LEGAL for new construction: Short Plat/subdivision L�G ��i7(���� /C- j`�Cti.i Lot No. (attach copy of long legal description) <br />OWNER ��,1 �����j ���;7 L. Phone/E-mail ��� :� Lj �` •3C� y'3 <br />Address � �� �,� (� �'z � L � � C � City/State/Zip �� � e� � ,��`j � <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�5 Ag@f1t _ T@fl8flf (must provide a letter of consenl from the owner fo do work in the space) <br />CONTRACTOR C ' r �� <br />�)C,t' �t �/ Ci�:Lili:,C,�C.�� State Lic. #;('�C 1�E/�) �` �J�.)C>.� City Bus. Lic. # �,X <br />�7 l � / /� <br />Address .�( C�, ���(;57 G1u./+[=�. '4! - ,(� c.2.11`�j �� G`��CJ Phone/Email �� C;(c� �,�`%V'j - 7 yU� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT �r? /. , <br />� � � , ) . �� t! /I .x L �fJ'i/% ��. _ <br />/ <br />(.�.�z��r� � �<� -�/ � �" -h a ,�-r�1�2_� :��� � �� � �f_� <br />� Phone/E-mail �v 4:- ' j <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��iCiC_%• `� <br />Existing Use of Building /�/�/2lt'�ix" `)�`GC.�• HEAT SOURCE: <br />� , / <br />Proposed Use of Building �,(� /(:%[JL-/�(I`LG!1�—�' Gas Electric_ Other_ <br />Building type: _ Single Family _ Duplex _Townhouse Multi-Family lf Commercial <br />Type of project: New Addition Remodel Repair 1/T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : � „� <br />� , � . � �,� � �� <br />� � <br />`C-� � ('�����r'�� � �l k � �.j � U� ( %� ,�i �='�� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _,Repair <br />Show Number (#) of fixtures Show Number (#) of fixtures <br />I A/C — air handling units � Toilet <br />� Forced air systems ' Bathtub <br />Gas piping j Lavatory (wash basin) <br />I Water heater � Shower <br />! Gas fireplace � Kitchen sink & disposal <br />Gas range Dishwasher <br />! Clothes dryer � Clothes washer <br />� Range hood j Water heater <br />� Exhaust fan I Sink (service/bar/mop/etc.) <br />Heat pump f Backflow preventer <br />! Unit heater I Urinal <br />Boiler i Drinking Fountain <br />� Refrigeration ! Floor drain <br />Woodstove I Grease trap <br />I Ducting Roof drains <br />/ � Other �i:=:: �,rL' ,:,+���, i Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM i Other: <br />� Number of Heads ! 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 authoriiy to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by,FY(e owne��thjs property to perform �ie work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />/� ' '' '�� ' ( `�, � � / l % `�Z. <br />���� � .�� / y <br />Owner/Authori ed Agent Signature �- Date (Revised 3/2013) <br />