Laserfiche WebLink
, <br /> PERMIT APPLA�:ATION <br /> BUILDING/MECHANICAL/PLUMBING/SIG�V/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERNHT 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 Z ��S ""�Z <br /> SITEADDRESS; ;-� , PROPERIYTAXp P RMIT# �_OO <br /> (��- (�\ � .� .c/ �.� <br /> LEGAL lor new construction: Shorl PIaVSLbdivlsion Lot No._ (altach eopy ot long Iegal descrip�ion) <br /> OWNER , ,� � �\ PhonelE-mail <br /> ddress CirylStatelZip y� � � e't' b <br /> CONTRACTOR _ L 81 Lic.# S. r.n <br /> Address O� !a„ �� PhonGEmail - .00 L <br /> j6yrS�s " �'+: � <br /> TENANT BUSINESS NAME C NTAC FOR PERMIT -7��P5 Q�� <br /> J 1 <br /> � � PhonrJE•mail -�. —2 —�n 2 <br /> . � <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFWORK,� �+l��o <br /> Exisling Use of Building HEAT SOURCE: <br /> Proposed Use ot Bullding Gas_ Eleciric_ other_ <br /> Buildingtype: _SfngleFamily _Duplex Townhouse _Multi-Family _Commercial <br /> Typeotproject: _New _Addition _Remodel _Repair_T.I.�Sign_Sprinkler_DemoliUon_Change ofUse <br /> Desaiption of Wotk(addiflonal space provltled on fhe back): <br /> �'Y�Sfti (� Z. IA.�l I) ��'1^r <br /> Havo you started working without a permit7 _YES NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _Now_Atldn _Alteration_Repalr TypeolProject: _New_Addn _Alteratlon_ftepalr <br /> Show Number(p)olllxfures Show Number(N)ol llrfures <br /> � AIC-airhandlingunils Toilet <br /> � Forced air s stems � Balh�ub <br /> Gas pipin Lavato (wash basin) <br /> � Waler healer Shower <br /> � Gas fireplace Kitchen sink&disposal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhausl fan Sink(servicelbar/mopletc.) <br /> Heat pum Backflow reventer <br /> Unit heater Urinal <br /> Boiler Grinkin Founlain <br /> Refriqeralion Fioor drain <br /> Woodstove Grease tra <br /> Duclin Roof dreins <br /> � Olher Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Head: Other. <br /> I hereby certiy that I have read and examineu Ihis application and knav the same lo be Irue and correct.All provisions ol laws and ordinances goveming <br /> this type of work vrill ba complied withw�elher specified herein or not.The gren�ing ol a permit does not presume lo give authority to violate or ancel <br /> tha provision of any other stalo or local law regulating wnslruction or lhe pedortnanw ot construclion.That I am authodzed by the owner ol Ihis pioperry <br /> lo peAorm tha work far which applicatlan is made ard I comply wilh�he State Conlractors Law 78.27 RCW and 298100 WAC <br /> ,��-�-� �--- y�- [�- <br /> Own r� 9enfSigna{ o Dato (ftevised?/2011) I <br /> /a <br />