Laserfiche WebLink
� • <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBI�JG/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: � PROPERTY TAX t# PERMI # <br />�30� ��.�����1 �,�>�-k i�,��..�, Z� ilt� � 1�iZ "��'C�( <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER ��J� Z...^.��t� y-�� Phone/E-mail ��L J^" 3`I �l' `Z 1 j�G <br />Address � � �U �SG ,,, �ic� City/State/Zip ;� u� ,� ��,. ` 5 F� r,'� � �.'� � �G L 1 � � 2 Z j � <br />jT- <br />APPLICANT: _ Ownef _ Owne�'s Agent _ Cont�actor _ Contracto� 5 Agent _ Tenant (must provide a �euer of consent irom the owner to do work in the space) <br />CONTRACTOR . «v�''' � -�^�T`�I�.�1,�^ ' �`as; �� �State Lic. # A��v� i �4 `j � � � �"1 City Bus. Lic. #�j3 `13� <br />Address � L�� '/ L li �' fr' e -- �� �� � ��.i � (,.�J� J� � � Phone/Email �( L�� `I�rJ' - �%,3j!% `l �l � `��u': .�.,�. .,, <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />Cril �C,..0 �' r�-� ! � j,���L!' Phone/E-mail L`.1 �^ --. T S b� ✓�^�.2 ( �� L�'_ ��3 _i.� 7U � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��3 b �`1 / U <br />Existing Use of Building _ HEAT SOURCE: <br />Proposed Use of Building _ 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 />DESCRIPTION OF WORK (additional space provided on the back) : <br />�,,-�..1► �� .�,��� U- �,_, ld-��� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I A/C — air handling units <br />� Forced air systems <br />': Gas qipinp <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />i Toilet <br />i Bathtub <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />� Heat pump I Backflow preventer <br />Unit heater I Urinal <br />! Boiler i Drinking Fountain <br />j Refrigeration � Floor drain <br />; Woodstove Grease trap <br />I Ducting Roof drains <br />� Other 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 permil 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 authorized by the owner of this property to pertorm the work for which application is made and I compry with the State Contractors Law 18.27 RCW and 296 200A WAC. �� <br />� <br />f i Z 2�i/ �� , <br />Own rlAuthorized Agent Signature Date (Revised 3/2013) <br />