Laserfiche WebLink
ERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/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: ROPERTY TAX# PERMIT# <br /> //2?33 C --/4-(}- - 77�l• P(:)/03T,6) CDC f 00 • /21t1—U6 7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of!Ong legal description) <br /> OWNER 71.-5P)4t}0 (i. 5 '4'/5(L eik—bd.Ict re_ e c Phone/E-mail <br /> Address 6 5 Lc) I`�� 1 �(, 5 _ City/State/Zip E►ei f(J 5 OA_ `T, O 2-61 <br /> APPLICANT:_Owner _Owner's Agent (Contractor! Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 1 cq K t p-c,, �[.. u L rr✓ `,c��c�. State Lic. # /..44K /0,1 eviy <br /> L ityBus. Lic.# ){� rQ(�; <br /> Address _ Lj 2 `r5.-Z�:, Phone/Email Z �T Z C�./ e <br /> U Z 2 S ( 5 � � 1)1ni1� [ �U Gft�lr.� <br /> �' • n't'� p i ` % B o✓p CONTACT FOR PERMIT <br /> - <br /> h'vb� i Ark I j,1'� V'i-V Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 'i boo, <br /> • <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: Single Family Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> t NAY—' <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 j Backflow preventer(inside bldg) <br /> Unit heater ( Urinal <br /> Boiler j Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove ! Grease trap <br /> Ducting Roof drains <br /> Other i Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM f Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting 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 6w er o is property 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 /> ¢Zz 5/r5//s <br /> Owner/Authorized Ager g e Date (Revised 4/2015) <br />