Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGNlSPRINKLER/D-'MOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-257-8857-www.everetM•a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROFERTY TAX p PFRMIi A <br /> S'y ► � Wes} De. o000 90�- - <br /> LEGAL br new constmction. Shotl PlaVsubdivision Lot No_ (altach copy ollong legal descnplion) <br /> OWNER e, 1 C\ark PhonclE�ma�l �5- 44•5'1 SGtY.r1�� ` <br /> Co . <br /> Addmss y\ ��g+ nf. CirylStatelZiO R - O <br /> CONTRACTOR L 8 I Lic. # <br /> Address P�one/Finail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonefE-ma�l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of BuAding s/,(((�C6 fQH(�Y ��$/R�EAlCE HEAT SOURCE <br /> Proposed Vse of Building�f� W�"[N ADu. Gas_ _ Eiectnc_ Other__ <br /> Building rype�. ✓Single Family _Duplex_Townhouse _Multi-Famdy _Commercial <br /> Type of pro�ecl�. _New ✓Addition _Remodel _Repair_TJ._Sign_Sprmkler_Demo6lion_Change of Use <br /> �escrip�ion of Wo�k(adddiono�space provided on ihe back)�. Qov�:>}P V G� L\ �j g dfOoi(11 C O� n eG��n ��' <br /> hovse -�-o t1�Q ga�c.c�.¢.,.Le9a1"�z.e s�v.d'�o fkpi- abov� c�arqc�5�I1Du�, <br /> Have you sWRed working without a permit9 _YES ✓NO <br /> MECNANICAL PERMIT APPLICATION P'LUMBING PERMIT APPLICATION <br /> Typa of proJecl: �New,�Addn _Altoratlon_Repair Typo of Pro�ocl• _New__AEEn _Alleration_Repai� <br /> 5how Number(N)ollixfures S�ow Number(MJ ol fixtures <br /> A/C-air handling umts Toilet <br /> Forced ah systems Bathlub <br /> 1 Gas piping Lavalory Iwash basin) <br /> ( Water heater Shower <br /> Gas fireplace � Kitchen sink 8 tlisposal <br /> Gas ran e Dishwasher <br /> Clolhes dryer Clothes washer <br /> Ran e hood Water heate� <br /> � Exhaust lan Sink(serviceibarlmople�c� <br /> Heat pump Back9ow preventer <br /> Umt hcater Urinal <br /> Boiler Drinking Foun�ain <br /> Refri �fation Floordrain <br /> Woodstove Grease Irap <br /> Duding Rool drams <br /> Othar Medical Gas <br /> SPRiNKLER / SUPPRESSION SYSTEM otner <br /> Number ol Heads Othec <br /> I hereby cetli��Ihat I have�ead and examineU Ihis apptication and know t�e same lo Se Irue and correcl All pmvisior�s o�laws an0 o�tlinances governing <br /> Ihis lype ol work will be compilea wilh whelher specified Irerein or not ihe qranling ol a permil Aoes nol presume lo give authority to violate or cancel <br /> Ihe provision ol any other state or local law regulaling conctruclion or the pertarmance ot wnstruction.Thal 1 am aulhotlzeA by Ihe nwner ol this pwpehy <br /> to peAo m Ihe work for which applicalion is made ana I comply wilh Ihe State Contractors Law 1827 RCW and 296.200 VJAC <br /> 6-�0-► � �(a <br /> n n uMor e Agant5lgnature Date (RevlsedY1017) <br />