Laserfiche WebLink
� <br /> F'ERMIT APPLICATION <br /> BUlLDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PEFMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 �vww.everettwa.org <br /> S'TEADDRESS: i�� �7 (pII� C �✓�� PROPERTYTA%tl PERMITA /� I � <br /> (/ l/ <br /> LEGAL for new cons�ruclion: Shorl PlaVsubdivision Lot No._ (attach copy ol long legal description) <br /> OWNcR {/ �. ) C. Phone/E-mail y Z) - z��� —� 77� <br /> Address � ��L-) �e/li' L CitY/5lale/Zip (!C' lf , � ��l <br /> APPLICANT: O�vner OwnersAgenl CaNractor CoMractorsAgenl _TenaMlm�sicmraeaiesero�co�sem��ommeownenodo»orxmu»spa:e� <br /> CONTRACTOR l� +� �� �h '� C State Lic.# � �� e( y.l�/�✓ "' City Bus. Lic.� <br /> Address ! 7� iV 'l � � �� �"/���2'L "".'I �L ( ? PhonelEmail 3C-�-7yY- 7/ 6`/ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT. �(2�-SL�j_y�� 7 <br /> �eJ�� S{��. n <br /> Phone/E-mail �1� L 5 � � N.'G��� < <°'�� <br /> BIIiLDING PERMIT APPLICATION CONTRACT PRICE OF WORK �7 k5 ��� <br /> Existing Use of 6uilding ��-!�'S� ��`^ �a HEAT SOURCE: <br /> Proposed Use of 8uilding /`i�""�- Gas_ ElecMc _ O�her_ <br /> Bu�lding type: �Single Famil� _Duplex_Townho{�se _Multi-Family _Commercial <br /> Type o(pro ect: _New _Addition _Remodel ✓ftepair_T.I._Sign_Sprinkler__Demolition_Change of Use <br /> DESCRIPTION OF WORK�additional space providetl on fhe Uack): <br /> �e _ r��� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project: _New_Addn _Altoration_Ropalr Type of ProJecl: _Now_Addn _Altoration_Ropair <br /> Show NumGer(N)o//ixtures Show Numbcr(N)o//ixfwes <br /> A/C-air handling unils I Toilei <br /> � Forced air systems � BathWb <br /> � Gas piping � Lavalory(wash basin) <br /> � Waler heater I Shower <br /> Gas(ireplace , Kitchan sink 8 disposal <br /> i Gas range i Dishwasher <br /> Clothes dryer I Clothes washer <br /> f Range hood I Water healer <br /> � Exhaust fan � Sink(service/badmop/etc.) <br /> � Heat pump I E3ack(low prevenler <br /> I Unit healer I Urinal <br /> � Boiler I Drinking Fountain <br /> Refrigeretion I Flocr drain <br /> Woodstove I Grease trap <br /> Ducting I RooFdrains <br /> ( Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM I Other: <br /> � Number of Heads I Other <br /> I hereCy cetlAy ihat I havo reatl anC exomined ihis apF�:wtion antl know Iha samo•��:�i�o and mrrect.All pro�isions ol laws end ordinances goveming t�is type o(work will be complied <br /> �run Nhet�er speci(ietl�erein or noL T�o9mming ol a pemit tloes nol presuma to grvo��NhorOy to v�olate or cencel Ina pravision al any oNer state or laal law regulaling wnstruclion <br /> Tnat I,m authonze0 Ey Ihe owner ol N�s prcperty lo Fertorm Ina work Wnvhich appliwtion is maUe entl 1 wmply wnh Ne State CoNranors Law 18 27 RCW antl 296100A N'AC. <br /> � �, �_ ��_JS -I � <br /> � � Dale (Revised 3/2073) <br /> OwnDdAutiiorizeE Agont SlgnaWru <br />