Laserfiche WebLink
PERMIT 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: PROPERTY TAX# PERMIT# <br /> 15 I .' &1- E IO.5-�3 ooc �5 b 1, DcM- 04D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER `( t 0,..A1 a 2 r S — phone/E-mail 9 CSo, 3 q I . ia <br /> Address city/State/Zip <br /> APPLICANT;_owner _owner's Agent Contractor Contractor's Agent Tenant(most provide a letter at consent from the owner to do work�in the apace) <br /> CONTRACTOR .� r\A9 State Lie.#��,yu,r.L q-J, ea City Bus. Lic.#dot g a J 0 <br /> Address D1 �. ` Le..... at ttn.o$ Phone/Email `O .a Li S `41 01Z)TEN NT BUISI SS NAME CONTACT FOR PERMIT J �a.‘mj 4. O. ( ,W 4n <br /> i. , Phone/L-mall 1 Qa Mil-L ,{Jl le\fi . GNr <br /> O1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK i%if 0 40 <br /> Existing Use of Building e r HEATRSOURCE: <br /> Proposed Use of Sui)ding_ Gas �Efectrio Other <br /> Building type; _Single Family Duplex_Townhouse Multi-Fatily Commercial <br /> T e of ro'ect: New Addition Remodel Re air T.I. Sign Sprinkler Demolition Change of Use <br /> DESC IPTION OF OR (additional p8CC provided on f back): <br /> ins t� , �, -fin a_ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Adds I Alteration Repair Type of Project: _New_Addn Alteration Repair <br /> Show Number(#)of fixtures _ Show Number(#)of fixtures <br /> f. A/C—air handling units Toilet _ <br /> Forced air systems _ Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower _ _ <br /> Gas fire.laoe _ Kitchen sink&disposal <br /> Gas ran.a _ Dishwasher <br /> _ Clothes dryer Clothes washer <br /> Range hood Water heater <br /> R <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 end examined this application and know the same to be true and correct.All provision;of law;and ordinances governing this type of worts will be cvmp <br /> 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 /> I em authorized by the own:r of this property to perform the work r which pplication is made and I comply with the State Contractors Law 18.77 ROW and 296.200A WAC. <br /> . . • 1, 1 L <br /> net/Authorized Agent Signature Date (Revised 9/2014) <br />