Laserfiche WebLink
NERMIT APPLICATION <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: ��,p,�', �r PROPERTY TAX# +� PERMIT# <br /> ���'� �'� JI�'C.S� ���'���.�,�y�i�' �'��7SI G�JU IG,[�'IC�(U � % - <br /> LEGAL for new construction: Short PlaVsubdivision [���/�,� '�'J�(,��/�� Lot No. "l�t (attach copy of long legal description) <br /> OWNER �►�n-�/���. C��OYIUIL'I1��5 Phone/E-mail '�53 �`��' �L�` o"io`! <br /> v n il.�-�,c rn��t�Gnmv��li;,� � .v� <br /> Address 1,2�>�S �,1j'�1.� C%N �� � S1,-1 � � City/State/Zip PV�-)C�l.�lv � C�r;4 `i �3�3 <br /> CONTRACTOR ���1 I�/-2 (,�l�/)`l(;1 I�,�,T��S L& I Lic. # ��'���1 L( ��j 7�J C <br /> Address <br /> �,�',l� C��4rl1��A.1 ��,SU��T�� I�iJ��il1,U1°G(1�4 ��3i�3 Pr,o�erEma�i��� �l����uc� ncornmun�hC���c� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT m��� ��� �A./rJ S i7 C4�lt�. <br /> �;�5���;�{�, I�l�l1� h !O�! <br /> Phone/E-mail mV�l��h���i.k -C � ' CC)l19iy1�L� �E'� C�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building ��,�} HEAT SOURCE: <br /> Pro osed Use of Buildin 1�,,� � <br /> p g IU�C_-1.L � k C/���t 1n CL 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 /> c�ti�s�i�<��cri�ti� �F .t��v�c,�' S����1� ��t-m� L�� l�tS�` �D��IiC� <br /> Have you started working without a permit? _YES X NO y�ri�/`��� �/l�� <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 /> j A/C—air handling units j Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace � � Kitchen sink&disposal <br /> Gas range Dishwasher <br /> 1 Clothes dryer Clothes washer <br /> ( Range hood Water heater <br /> � Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> , Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> � Ducting Roof drains <br /> '��� Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM 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 <br /> this type of work will be co ied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the�ro ision o other e or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> o perf m the w rk or hi plication is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> 1 ^ <br /> c,i c � � �-i ��. �o l�31►, <br /> O erl utho ' ent Signature Date (Revised 2/2011) <br /> _\ <br />