Laserfiche WebLink
'__ � <br /> �PERMIT APPLICATiON <br /> BUILDING/MECHANICAUPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8657 www.evereriwa.oro <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM `—�� '—� �` <br /> PROPERTY TAX N PE IT i <br /> SITE ADDRESS: � . 1 - / !'r �-�.'�� f 'f_���!i I J '� � <br /> ,� � �. i, r , ����iI�J !�' -�i 0 -1 n <br /> LEGAL tor new consWdion: Short PlaUsubdivision Lot No._ (atlach copy of lorg legal descriplion) <br /> J � . — - .7, J �. <br /> owHeR�`i:1��=f-�' l_ C ��4 :��. V,i-r i. !�<s-� Pr�o��e-ma�i �/_�?- - % =� %� - -• <br /> Address � � : .�.� � -�lf� ��i; /J. ��-t:, CitylStatelZipi � -- -� � / i �C�. ti �'—� <br /> APPLICANT:_Owner OwnefsAgent �Contrador ConUadorsAgent Tenant(m�s�nwbeun�mrace^semtm�"°'°°"Tb'ro°°"°^`^°'°"p�� <br /> CONTRACTOR � 1 I'� � �� � I � � �'i<. L�-1�, ` — L 8 I Lic.#�/� � � � �if�COE Bus. Lic.# /73 <br /> ddress SDD✓/ � r � /1��� � Qr Sv�l(,Q. �� Pnoa��u yo�57s4 yUU� <br /> TENANT BUSINESS NAME CO�CT FOR PERMIT <br /> � Tf1 D rS �� <br /> Phone/Hnai� <br /> BU/LDING PERM/T APPLICAT/ON CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of�ui�ding Gas Elearic other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commeroial <br /> 7 of ro'ecl: New Addition Remodel Re air T.I. Si n S rinkler Demolilion Chan e of Use <br /> DESCRIPTION OF WORK(addifional space provlded on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o(ProJect: _New_Addn _Atteration_Repair Type of Project: _New_Addn _AlOsntlon_Rapalr <br /> Show Num6er(N)o(fixtuies Show Number(NI o/fixtuies <br /> � A/C—air handlin unils Toiiet <br /> Forced air s stems Bathtub <br /> Gas i in Levato wash basin) <br /> Water heater Shower <br /> � Gas fire lace Kitchen sink 8 dis I <br /> � Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood lNater heater <br /> � Exhaust fan � Sink servicelbar/mo etc.) <br /> � Heat um Backflow preventer <br /> � Unit hsaler Urinal <br /> Boiier Drinkin Fountain <br /> Refi eration Floor drain <br /> Woodstove Grease tra <br /> Dudin Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other. <br /> Number of Heads Other. <br /> I herehy ceMy t�at I have read and examined Ihis applicstbn and know�he saRe lo be We erM mrrecl.M provisio�a a�law�e�d°b'^ances govemirp this type o'wak�be mmPNed <br /> wilh whelher speafied herein or nol.Tha granting of a pertnil doas�wl presuma m give euUarity ta videta w�a�el�ha Pfovisiw�ol e^Y°�'+�e°r bral lew�p"�^g�°^s�^� <br /> Thet l em aulM�aed 6y Ihe wmer oi lhis propeM�o pertorm Ilx wwk for which appf�stion is maOe aM I compy�M�Ne S�a�e ConVarlors Law 1827 RCW aM 2Bb.Z00A�NAC. <br /> �' �' �// � <br /> ��,� � " I--l���..��� l � z <br /> ner/Aut rized ABent Signature Dale (Revised 620121 <br />