Laserfiche WebLink
y� g -�� <br /> PERMIT APPLICATION <br /> BUILDiNGlMECHANICAUPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-7.57-8857—www.evereQwa.org <br /> APPLICATIONS ARE ACCEPTED FROM t AM TO 4 PM <br /> SIT ADDR 98: � ' � �n` VE PRO►EIITYTAItN PEIdAIT�y, , _� I�y <br /> �� �� � <br /> LEOAL lor new constrvclion: Shoh PleVaubdivlelon Lot No._ (atl�ch copy ol lo�p leqd detuiptlon) <br /> OWNER y C ,� �,���J� PnonME-mail as- S' ` <br /> dOre�a .�Li�INt�� , ciyismerziP �veJOff' l/� 9�J.D3 <br /> CONTItACTOR ✓'�'i. A� L 8 I Llc.N <br /> ddrea� 4 � Cl�! QE'A1 N-� £Vl�(l� �ll�j PhonalEm�ll ��j�— �$8 <br /> A <br /> PhonslHnail <br /> SUILDINO rlRMIT A��LICATION CONTRACT PRlCE OF WORK_�OQO, Oe <br /> Exlsting Use ol Buitding f"E��-1E. HEAT SOURCE: <br /> Propoaed Uee ol Building Oai C ebctr�c other <br /> Building type: �Single Family _Duplez_Townhouse _Multl-Femily _Commerciel <br /> Type ot proJed: _New _Addition _Remodel ,Z Repa�t_T.I._Slgn_Sprinkler_Demolition_Chanpe ol Use <br /> DeeCdp�10�01 WOfk(edditbnel spate pmvlded on fha beck): ��lae C 6,� ���a ' <br /> CoS�{' �5,ood , �= [ c�as) <br /> Have you�farted working without�permlt7 _YES �NO <br /> MlCMANICAL �ERMIT APrLICATION rLUM�INO rlRMIT Al�LICATION <br /> Typs ol ProJ�et: _1Nw_Addn _Albntlon�R�palr Typ�01 ProNcl: _!Nw�1dA� _Arbnllon_Rpdr <br /> ShowNumD�r/M/olpituns lhowNumMr o/fl+Nns <br /> A/C-eir handlin units Tollet <br /> Forced air a atems Bathtub <br /> Gae i in Lavato waeh besin <br /> Water heater Shower <br /> Gas fire lece Kitchen sink 6 dis fal <br /> Gae ran e Olahwaeher <br /> Clothes d er Clothas waahar <br /> Ran e hood Water heater <br /> Exhaust lan Sink service/bar/mo /atc. <br /> Heat um BackOow revanter <br /> Unit heater Urinal <br /> Boiler Drinkin Founlain <br /> Refri eration �Inordraln <br /> Woodstove Grease Ire <br /> Duclin Rool drains <br /> Other Medical Gas <br /> SPRINKLER/ sUPPRE8s10N SYSTEM other: <br /> NumberolHeads Other: <br /> I hereby cJrlity Ihat I have read and exemined Ihla eppllcallon and know Ihe eeme lo be irue and wnect.All provlaione ol lawe�M ordinances povemirp <br /> this type ol work wlll 6e complietl with whether spedlled hereln or not.Tha prenlinp ol a perml�does nol preeume lo pive suthodty to violde or uncel <br /> Ihe provlsipp of eny olhar slate or local lew regulatinp conflruc�lon or iha peAormance ol conel/uctlon.TAet I am au�harized 6y iM owner ol tMt property <br /> to pe orm�lhe�wo'rk lo� Irh 9 plil cellon I�meGe and 1 comply�I�Slale Coninctore Lew 18.27 RCW antl 2D8.200 WAC <br /> .� \ (` <br /> ��.L1�1 `� O OZ�J(/ <br /> Owna lAuthoriz�d A nt Slpn�turo Dale (Revlaed?/1011) <br />