Laserfiche WebLink
PERMIT 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 /> SITE ADDRESS: PROPERTY TAX tt PE MIT# <br /> Z31-c, ti,"‘"-` ST e2,xi E" N-1Q4-., 6c '19-1100a/2oov kd(PUb9 9d <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)� - �/ <br /> OWNER ,... (,),... (,) rG 4..-TER..R. t /4IC��a /S Phone/E-m J '2(° -1 1 - <br /> . y( ll 1(1/ tlllrA(t), CO ii" <br /> Address Z f (,p 6,14^ 5I— City/State/Zip Ev«e ti"--1 UJ of n -p <br /> APPLICANT:_Owner (_Owner's Agent _Contractor _Contractors Agent _Tenant(must provide a letter of consent f-om the owner to do work in the space) <br /> CONTRACTOR 5 PSV 6- State Lic.# City <br /> Bus. Lic. # <br /> Address 1 LA A IS tA.L l< oty t 4-- 9 VI 2 7 3 Phone/Email - <br /> TENANT BUSINESS NAME 1 CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building ,/ /� HEAT SOURCE: <br /> Proposed Use of Building R v ± e*/'49 G Gas Electric Other <br /> Building type: Single Family Duplex_Townhouse Multi-Family Commercial <br /> Type of project: x New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): r r � �G / <br /> gk,/ ( leve t_oie Z2kS- z / G /�.c41L- f.D/ si-en <br /> -O Gf a ,pt e. , <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 /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping j Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> 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 i Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting ! Roof drains <br /> Other i Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j 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 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 perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I tale4 <br /> Ow thorized Agent Signature Date (Revised 3/2013) <br />