Laserfiche WebLink
� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVFRETT PERMIT SERVICES <br /> 3200 Cedar St., 6verett, WA 98201 425-257-8810 FAX 425-257-8857 www.evere�twa.org <br /> � -a-2-1�{ <br /> SITE ADDRESS: PROPEN7Y TA%N P RMIT� <br /> Oby3803�1o1S�o �I 6 -00"7 <br /> LEGAL lor new wnslmU�on� Shon Plavsuodrvison Lot No._ (atlach copy ol long legal tlescnpiion) <br /> OWNER�/Y� 1.� Y� N c p�� Ph�nME-maJ <br /> naeress I b3( - �ke� F�r c�irisi�i�rz�v <br /> APPUCANT: Owner _Owner'sAgenl Conlraclor _Conirador'sA9ent TCndpl�must0�oraoniouerolcorsenluo.ninno+nerbEowohininospr.e) <br /> CONTRACTOR � (5 ti1 G_ State Lic. # p (Q3D`L Cily Bus �ic. tt 0(�OS <br /> �dAress PhonelLmail <br /> TENANT BUSINESS NAME CON CT FOR PERMIT <br /> ��K �I/���n (�f�z,-� ���_�s�� <br /> Phonc _-ma�l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �00°' <br /> Exisling Use of I3udding HEAT SOURCE <br /> Proposed Use of Building Gas Eiectric Oiher <br /> Buiidmg type-. _Single Family _Dupiez_Townhouse _Mulli�Family _Commercial <br /> Type ol pro�ect _ New __Addition _Remotlel _Repair _ T I. _ Sign _Sprmkler._Demolition Change of Usc <br /> DESCRIPTION OF WORK(a�fe�nanai sn��e pm�ided on mc nock) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Pmject: _New__Addn _Alleration_Repair Typo of Projec�: _New_ Addn _Alterafion_Repair <br /> Shaw Number(p)ollirfures Show Nurtrbcr(k)ollirfures <br /> AIC -a�r hantllinq untls Toilcl <br /> Forced air systems � F3athNh ' <br /> � G�s pipiny Lavalorv(w,sh basin) <br /> � Water heater � Shower <br /> � Gas�irCPldcc � Ki�Gher,5ink 8 disposal <br /> Ga;range D�shwasher <br /> � Clothes dryer � Clolhes washer <br /> Ranyc hood � W;ticr hea�cr <br /> Ezliaust lan Sink(scrvicdbarlmop/Mc) <br /> f leat pump � �ackflow preven�er <br /> Und healcr Unnal <br /> f3odcr i Drmking Founlain <br /> Reingcr.Imn Floor drain <br /> Wwdslovc Grease Irap <br /> �)�C���� ��00(�f.31t15 <br /> Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Numbet ol Hc.ds I Other. <br /> I bempy cendy lh:tl l n':C red9 pn4 0ram�n`d I�is JppbcO!ion nntl Ano,v Ihe somC lo be lme end carre[I PII pmvrsions ul IT.vs antl ortivdnce:9nvern.og Ih�s lype oI woik wJl��p r.omphrrl <br /> wffi� �per:prcilie, �ereinornUl IN:qrani�n�plapnmitaneSnolDicSumeloqiveaulnonlylov.nlalenrcancCllMpmvis�onolanyclhmslalcoriotallawregvlaUnqwn;lmdion <br /> 1 tial am ai oumU�� IM1e OwnM Ol lhis propcify la peiimm IAc vmd fa�w�rth apPH<aiinn i:maN•an�I comply wi�IM1e Slalc ConlrarJon la�v 19 J7 HCW and 7Y4 200A WAf, <br /> �.-- � 22 �`� <br /> Owncr/Authorimd Agml Signalure Dale p:nm:ed 3/'�Or)) <br />