Laserfiche WebLink
; <br /> PERMIT APPLICATlON <br /> BUILDINGIMECHANICAL/PLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-881p FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��a._.�� � <br /> SITE ADDRESS: - i P�C' [ PROPERTY TA7f N PERMIT/ <br /> a iC� ., j/ z � T �l/�. -'t��T l�A il� � � > > - .� <br /> LEGAL fa new consVuction: Slwrt PlaVwbdivision Lot No_ (attach copy of lag legal descnPtion) <br /> q S c.C.7� <br /> OW11ER � b�N. S •' '7, � / �/ , �/�/^ � PhonPJE-mail j y'� . .S�/��Z�l C:2 � �/' C�./3 ti%�✓� <br /> aress cay�s�a�erz�v i . .� - ivr� � ,Q.�-C l <br /> APPLICANT:�,Owner OvnxYSAgenl _Canlractor ContractofsAgent Tenantl�++s�p�.baeram+xm^a^va�rbeo"°^'^�^ewaml <br /> CONTRACTOR Yb'AiL��- C-' 1�75 .T C/ L 81 Lic.#/T ". .�0..•f/ / .�� ���Bus. Lic.# <br /> /l�SD ' N��- � s��. ici �r,'�'<<-�r ����+. � <br /> ACdress 1 rC'• � r PhawJEmail ��' ,f • ,} •f y <br /> TE T BU INE S NAME CONTACT FOR PERMIT <br /> G D'i'�1'C. � d 1 5 rL:'--j e /i <br /> PhonelE�mail <br /> BUILDING PERMIT APPLICATION CON7anC7 PRlce oF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other_ <br /> Building type: _Single Family _Duplez_Townhouse _Mulli-Family _Commercial <br /> T of ro'ect: New Addition Remodel Re air T.I. S' n Sprinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(addrtional space pmvided on the back�: <br /> /d�y/ G (. C-rS S/ ..rJ L'% SJ(, /.-� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolPm�ecL• _New_Addn _Alteralion_Repair TypeofPrqecL _New_Addn _Alteratlon_Repair <br /> Show Number(a)ol firfures Show Number(R)01�rtures <br /> I AIC-airhandlin unils I Toilet <br /> Farced air s slems '� Balhtub <br /> ' Gas pipin i Lavato (wash basin <br /> ' Water heater ' Shower <br /> Gas fireplace I Kitchen sink&dis osal <br /> Gas ran Dishwasher <br /> � Clothes d er Clothes washer <br /> Ran e hood Water healer <br /> Exhaust lan � Sink(servicelbadmopletc.) <br /> Heat pump Backflow reventer <br /> ' Unil heater Unnal <br /> Boiler I Drinkin Fountain <br /> Refri eration i Floor drain <br /> � Woodstove i Grease lra <br /> Ductin Roof drains <br /> . Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> � NumberofHeads � Olher: <br /> I here�y ceNN Me�I have reatl anU examneC I�is eppicalan nnC lnaw 1�o sama lo Ee Imo entl mrrecl.A1 pmvisions ol IawS enE otEmances gaveming Nis ype ol woik wil ba compl�0 <br /> vnlh wtiet�ar sperdieC�erain or nol.Tha gmntinB of a partnil tlaas nol pmsuma lo B�o aW�mty to vblata or canwl Na pmvisbn of any oNer slala or bwl law rogulating conslructan <br /> Thal l em euthoiizaU�y Ne amerol t�ls pmpeM to pqda@ 1ne xro�k lor w1iiU aDD��bn is matle anE I tompM���e Slale Contradors Law 7817 RCW anE 299200A WAC. <br /> / � <br /> l � �� �%l��uJ G/7,/� <br /> � � �/fJ'C-��(�' „ �I � _ . � <br /> OwnedAulho ed Agont Signeturo� � ' �a�a (Revised 62012) <br />