Laserfiche WebLink
l <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Gedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8657—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: J 1 PROPERiYTAXp �'�'�(l� I tl P�jRMITM <br /> '� � Iru'i�l •'C.. (��-I ` , o '� Oo -Dl3 <br /> LEGAL lor newconslruction: Short PlaVsubdrvlsion Lol No_ (attach cnOY ol long�eg��descnplion) <br /> OWNER (' � . /ol� � CI`1 PhonelE-mail � - J�. -�/ ° �� <br /> Atldress �JI��� /�lti�.�i�. ����u �,'. City/Slate2ip /�l�-/�,/ i'� !,/ - � 7 <br /> CONTRACTOR �1' ^ L 8 1 Lic.# <br /> ddress Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT } ) <br /> C � I . i� � �� � PhonM&mail � �e � / ���1�{� ��l��C �/�� ��/Jr� � <br /> �i5(fi � .( J. <br /> BUILDIN6 PERMIT APPLICATION CONrrucr PRlce oF woRK a 70�J <br /> Exisling Use of Buiiding��"'fi���i���'� HEAT SOURCE: <br /> Pmposed Use of Building �J�-�-"�� '� � Gas_ Eiednc Oiher <br /> Building type: _Single Family _Duplex_Townhouse _Multi•Family �( Commercial <br /> Typeofproject: _New _Addilion �Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change ofUse <br /> Descrip�ion of Wotk(edddional spece pmvideC on Ihe backJ: �. � <br /> , - rlclo��. �I �i��U�'ll q,��1 C- IPJ��I�r' ctnd <br /> �n7��i� � �fi_ � »� �� �(:� ( t ! � CScI`�G,Oj .} vC(f�c..l OPrn;��JS <br /> Have you sWrted working wi[hout a permit? _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolProJect: _New_Addn _Alteration_Repair TypeofProJect: _New_Addn _Alteratlon_Repalr <br /> Show Num6er(N)ol lixfures Show Number fM)of fixNres <br /> � !VC-airhandlin units i Toilel <br /> I Forced air s stems i Bathtub <br /> � Gas i in I Lavalo (wash basin) <br /> i Water healer I Shower <br /> I Gas�i:e lace I Kitchen sink&dis osal <br /> I Gas ran e I Dishwasher <br /> � Clothes d er Clothes washer <br /> I Ran e hood I Waler heater <br /> I Exhaust fan i Sink(servicelbar/mo /etc. <br /> I Hent um i Back9ow revenler <br /> I Unit heater � Unnal <br /> Boiler Dnnkin Fountain <br /> � Rehi eration Floordrain <br /> I N�oodstove Grease Ira <br /> � Uuclin Roof drains <br /> � Other I Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM 'i Other: <br /> � Number ot Heads I Othec <br /> I herehy cedity Ihal I have reatl and eramineA this appliculion and know Ihe same lo Oe true and conecl.All provisions ol laws nnd ordinanws govoming <br /> this rype of v.ork wl��be wmplied vnth whMher specified herein oi not.The 9�anting ol e permit dces nol p�esume to give aNhonty lo violale or cancel <br /> the provision ol ony other state or local law regulatmg consUuction or the pedormance of construction.Thal I am aut�onzed 6y the ovmer of lhis propetly <br /> to perto � e work br which applicalion is made and I comply H+th the Stete Conlractors Law 18 27 RCW antl 296 200 WAC <br /> � ��____- ��- C� - � <br /> O elAuthodzetlAgent Ignature Date (Revised?/t01f) <br /> J�("� / I `((�'� � 1 <br /> /" <br />