Laserfiche WebLink
�ERMIT APPLICATI� <br />BUILDING/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: IPROPERTY TAX # I PERMIT # <br />�,% ,% � -' , ,�.�'��" L�3 I � � 5 CC.��i <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />OWNER `'� � J �,L} �. Phone/E-mail �. - � � `� 4 t1l�r` _ ' �,.,�;� <br />i:;>J�C� 1 .� ' <br />Address �, � �? �,. y City/State/Zip �,/� ��/.' � �" / �� ,;'��� .:"��,=" <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �m�si pro��de a ietter ot conseni rrom ine owner co ao work in me space� <br />CONTRACTOR � i J ; � /,�_- ,,-:' ; <br />Address r, � �1"r; / �.j � �p �% <br />State Lic. # City Bus. Lic. # <br />Phone/Email � �>., . � ` � . ,." ,r;' . <br />�, -- _� . _ <br />,�';/,� 1��i� �� �_ � ,' �,�:✓" ���'� , , . . . - Phone/E-mail � <br />I� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building (�� <br />Proposed Use of Building �J ' ^ �-- �� <br />Building type: ,_ Single Family _ Duplex _Townhouse _ Multi-Family :� Commercial <br />Type of project: New Addition �Remodel Repair _ T.I. _ Sign _Sprinkler _C <br />DESCRIPTION OF WORK (additional space provided on the back): <br />� <br />i � +- � �/°"- <br />� . - � <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />I Forced air systems <br />SPRI <br />vas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Ketrigeration <br />Woodstove <br />Ducting <br />Other <br />� SUPPRESSION SYSTEM <br />Number of Heads <br />PL <br />'ca . � <br />. C° �C-' L? <br />HEAT SOURCE: <br />Electric,� Other <br />on Chanpe of Use <br />Type of Project: _New _Addn _Aiteration lRepair <br />Show Number (#) of fixtures <br />i Toilet <br />� Bathtub <br />Lavatory (wash basln) <br />! Shower <br />uisnwasner <br />Clothes washer <br />Water heater <br />Sink (service/bar/mo <br />Backflow preventer ( <br />urmKing rountain <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 application and know the same to be true and correct. All provisions of Iaws and ordinances governing this type of work will be complied <br />with whether specifed 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 locai law regulating construction <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 />r <br />.�" � � .� ��(� I � <br />Owner/Authorized Agent Signature Date (Revised 4/2015) <br />