Laserfiche WebLink
PERM1TAP_ LICATION <br /> BUILDING/MECHANICA P /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# PiMIT ,pry <br /> Li tab C .✓C) v- c,bt(`� ,-;0000 Gj000 Y 1� apt <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER I.GtY'oL114.Ve S _WPhone/E-mail ci Z 5-- z S Z L1 3 .2 <br /> Address-, 7 7; 17_./vt A pi E City/State/Zip 73-(j <br /> APPLICANT:_Owner _Owner's Agent X Contractor _Contractor's Agent / Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTORCtIc 144P!>�o�� /4 V/1-1. (6 k 5 f-State Lic.# 46 3 (( Z- 1((1 City Bus. Lic.# L7 S y/g-I <br /> Address 1/1(06 ZZ1tt' ?I ft.,) Aoki"f(4(C2 721,4 ct' 1G1vl cFOL 3 Phone/Email ZG' XjE4 SL��fr/F .6 <br /> TENANT BUSINESS NAME2,J ` CONTACT FOR PERMIT <br /> NAME /1 .41 <br /> CIncd c' l f" CLr d gal41i e ee.tile, Cat..‘ <br /> Phone/E-mail 206" —76f�57 D j <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 5-r <br /> Existing Use of Building bcvyC c:--e HEAT SOURCE: <br /> Proposed Use of Building t)c&t/ e Gas)C Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _4-Commercial <br /> Type of project: New Addition 7 Remodel Repair_T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> W wt jr i' "" 1 <br /> t(,tw,(oili j 511)1Y /t t e5 7— fie <br /> h„ I„,SL �H ci147`04/ iv 4' e) ovtly _ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New,Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan _ Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and exami this-•: -lion and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp) <br /> with whether specified herein or not.The�� • ng of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized by the—- • .'moi o.erty to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �l / .c <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />