Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDINGIMECFIP:NICALIPLUMBINGISIGNISPRINYeLER/DEMOLITION <br /> CITY OF EVERETT PEkMIT SERVICES <br /> 3200 Cedar St., E�erelt, WA 98201 -425-257-8810-FAX 425-257-8857-www.everet�a.org'` �� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J <br /> ��SITEADDRE55: PROPERTYTA%p P R :iT4 <br /> 21 Gnw3YfivFvv��o�rw� 9e�o� ��3oZ — <br /> LEGAL�oi newca�simction' Sherl PlaUsubOrvis�oq Lot No._ (altach copy ol long legal descnpl'on) <br /> OWNER / /�/�✓E PhonWE�mail <br /> Aa:ress �Z (,p(a ,dVG CitylStatelZip E1'���i w'd 9$Z�� <br /> CONTRACTOR , �IGDF�S L 81 lic.# <br /> Address ZGo� 9�� AvE, ���35o sr��+r�� w� 98�2/ Phone/Email (�J 38L~3443 .kA':Selx�.r L b�l�r�r.a. <br /> TENANT BUSINE55 NAME CONTACT FO��SMI� <br /> G��(6T/X PhonME�mail �!a 2S -OB(a8 cvu� ��bn�'"���.cen <br /> BUILDING PERMIT APPLICATION cON7tucrPR�CEOFwoRK 300 000 <br /> Existing Uso of BuilAing NOSP/TAa C�.�'r'E��d` HFAT SOURCE: <br /> Proposed Use of Building /�r�7GES Gas_ Eieclnc_ Oiher_ <br /> Buildingtype: _SingleFamily _Dupiex_Townhouse _Multi-Family _Commercial <br /> TypeoFproject: _New _Addition _Remodel _Repair,�T.l._Sign_Sprinkler_Demolition_Change ofUse <br /> DeScriplion of Work(addi7ional space provided on(ho back):,^ 'N� O%F�GE �✓,�A«• <br /> �,4(ODE` O F D f.I� LAFE� <br /> Havo you slarted working wilhout a permit7 _,YES �.NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot ProjecC _New_Addn _Alteratlon_Repalr Type of ProJecC _New_Addn _AlteraUon_Repair <br /> Sboiv Number(a)ol firtures Show Number(p)ol IGriures <br /> A/C—airhandtingunits I Todel <br /> � Forced,ir systems � Balhtub <br /> � Gas pipin ( Lavato (wash basin) <br /> � Water healer Shoe:er <br /> � Ga�fire lace Kdchen sink&disposal <br /> Gas mn e Dishwasher <br /> � Clothes d er I Clothes washer <br /> � Range hood I Water heater <br /> � Exhausl fan I Sink(servicclbarlmo /ctc.) � <br /> Heai pump I Backilow preventer <br /> Unit hcater I Urinal <br /> � 13oiler Drinkin Fountain <br /> � Refrigeration I Floor drein <br /> � Woodstove � Grease ira <br /> � Ducting Root dreins <br /> I Olher � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Other: <br /> � Numbcr ot Hcads I Olhec <br /> I hercby cerlJy Ihat 1 havo reatl an0 ezamined Ihis application antl Anmv l�o same to be Irue ana correcl.All provisions ol laws antl ordinances goveming <br /> ih�s type ol woik will 6e complied xilh w�ether speciGed herein or not.The granting of a perm�l dces nol presume to give authonly to violate or cancel <br /> ;he provision ol any other stote or local law regulaling conslrutlion or the pertortnance ot consWclion.That I am authotlzed by Ihe owner of this pmpertp <br /> io pedorm t H�ork lor v.fiich app�icalion Is made and I comply wilh ihe State Conlractors Law 1827 RCW anA 290.200 WAC <br /> �,e, ,� ��u z-t.i/s I <br /> Own }Au ior ed Agenl Sign�t6re <br /> Date (Revised7/20ff) Z' <br /> L� <br />