Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDINGlMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Sl., Evarett, WA 98201 -425-2.57-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I - a'S`"I Z <br /> SITEADDRESS: PROPERTYTA%p P RMIT# <br /> I Op l0 13 fJ�,9l� SE C'��PH��'ri 9F1�`t�� �Eosl�lcc, Iv1�rc:r� � � <br /> LEGAL for new conslmclion�. Shorl Plal/ i division GR�f�4'�rF21) i�/1/'li Lol No_`-I� (atlach copy ol long legal description) <br /> owNeR (�:�ll]�C/'� CG'/I)/17v,�,''�I�5 �hone�e-man �.`1�53) �,�1�' lLl�lC7 ?�/[:�L1 <br /> Aad��ss�'�l S CANkC1'� �t�SOr�f aivrs�aieiz�p I�,C fl�LCU��' (,�.!A �f'-37 3 <br /> CONTRACTOR ��C.� )�C/� � •1�171�'���n� L& ILic. # r��/71��-( �L77�-` <br /> Address�.cSIS C�-N��(�',V� w!➢C �Si. F ��(,'l AL���/� l��1 `!L`-�73 PhonelEmail �.2��[:yC �Cf�l•' XlC'�/ <br /> TENANT 9USINESS NAME CONTACT FOR PERMIT . v.�i� ly'lo-./�`i <br /> iYlAeij,cE VAN -���UIEL L253,., 6 <br /> PhoneiE-mail �� � �nSYk) ��< I ' Yl � 7vAo/I�1i E'J�[C'y!� <br /> BI+ILDING PERMIT APPLICATIaIu CONTRACT PRICE OF WORK <br /> Gxistin� Use of Building �f( 4 _ HEAT SOURCE: <br /> Proposed Use o(Building I�'(J �S� ��i(lf/1 CC' Gas_� Eleciric_ Other_ <br /> 6uilding type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projecl: �New _Addition _Remodel _Repair_T� _Sign_Sprinkler_Demolition_Change of Use <br /> D2scription of Wo�k(additional space U�o��drd on thc backl: � , <br /> Con�1�.�,chcn �� c� 2ct.� �+ �lcsr� Ct,�Cc' �S�C� L�'� <br /> Have you slarted working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICNTION ( <br /> Type ot ProJect: �,New_Addn _Alteration_Repair Typo of Pro�ecl: �New_Addn _Alteretlon_Re�alr <br /> Shaw Number(N)o/fixfures Show N�mbei(q)o/fixtures <br /> A/C-air handling units Toitet <br /> Forced air systems 3 Ba1hWb <br /> �j Gas piping S Lavatory(wash basin) <br /> Water healer � Shower <br /> Gas(ireplace 1 Kilc!�en sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer � Clo;hes washer <br /> Range hood � Water heater <br /> Gxhausl(an �.���� Sink(service/bar/mop/elc.) <br /> Heat pump Back(low preventer <br /> - Unit healer Urinal <br /> Boiler Drinking Fountain <br /> (, Refngera6on � Floordrain <br /> Woodslove � Grease trep <br /> � � Ducting Roof drains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSfON SYSTEM � Other <br /> ` 1 I NumberofHeads X' Othec <br /> i I hereby cetlify Iha;I have read and ezamined Ihis application and know ihe same lo be Ime and correct.All pmvisions of laws and ordinanws goveming <br /> thi,type o(vrork wiil be coinplied wilh whett�er specified herein or noL The 9ranling ol a permit doea not preswne lo give aulhorily to violale or cancel <br /> the pwvision of an olher stale or I I lav re9ulatin�construclmn or the performance of conslruclion.Thal I am aulhorized by the owner of ihis property <br /> lo perfonn!ie1�'+oi oryAfiLt+�ppli al made and I comply wilh the Stale Coniractors Law 1827 RCW and 29G200 WAC <br /> I `/ 1 / � � I I �I (Revised 2R011) <br /> OwncrlA lhoriz gert�Si917aWFe Date + <br /> `-' I� <br />