Laserfiche WebLink
, <br />?ERMIT APPLICATI <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMQLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 982Q1 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />)DRESS: PROPERTY TAX # p� P RIM,✓IT # Q <br />O � � �� rr�V � � G �2��'�J I I�� �7���V � L `7� ✓" <br />for new construction: Short PlaUsubdivision ��—��-1 l—, Lot No. (attach copy of Ibng legal description) <br />ER �(�� -�� d d��o2Tr9e2� -��-�so �-�-C_ Phone/E-mail � ��. u� �,� .,�o c��'i <br />;S c d��� ��Ic�! �'IL�=g�tr� �ea/� .�� �c� City/State/Zip �s ,��-���5 � <br />ICANT: Owner _ Owner's Agent �C Contractor _ Gontractor�S A j211t _ TOflaflf (must provide a letter of consent from ihe owner lo dp work in the space) <br />ress �S� <br />N��'Z7�-+ c_ 2� �K r�4 PA 2TlLt �rlTS <br />BUILDING PERMIT APPLICATION <br />LE �State Lic. # <br />Q�21Phone/Email <br />S�lU2L'1 City Bus, Lic. # C�Ilo9-2Z <br />Z� �- 8 S 2�� 4-� �� 4- <br />���� r <br />Phone/E-mail 2� 3 - � 5 <br />CONTRACT PRICE OF WORK <br />t �-% , �i 7' 7 �`� <br />Existing Use of Building �laLi t- F�nn ��� HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric_ Other <br />Building type: ,_ Single Family _ Duplex _Townhouse i� Multi-Family _ Commercial <br />Type of �aroject: New Addition _ Remodel Repair T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />/Al��,�'1-� �.�d �F ,�.a9�'tl,•[�"C�r.� Cc��tPvS'� � �r�P�r4SP��-�)S�snlCL�S O�'�-r� <br />�d%d'� �iX1$���7 ��1G L� � �' ���ri2 �� G'���F'C�S'1�/a'Dt�/ S'�inlf-pL�. <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />� Forced air svstems <br />vvater neaier <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />PRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />j Toilet <br />Bathtub <br />hower <br />itchen sink & disposal <br />ishwasher <br />lothes washer <br />later heater <br />ink (service/bar/mop/etc.; <br />ackflow preventer (inside <br />urinKing rountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing lhis 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 autho ' d by e o r f this property 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 />1`,� �.� l S � <br />wner/Authorized Agent Signature D te (Revised 4/2015) <br />\I <br />