Laserfiche WebLink
r <br /> 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: L 3 C) F � �� PROP ,��� PERMITI <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER f�lr e f Phone/E-mail y <br /> Address City/State/Zip f-L� l O <br /> APPLICANT:4owner _Owner's Agent _Contractor _Contractors Agent _Tenant(must provide as letter of consent from the owner to do work In the space) <br /> CONTRACTOR l -,0- ��w-�� State Lic.# - �j �s City Bus.Lic.# <br /> Address Phone/Email <br /> TENANT BLJSINESS NAME CONTACT FOR PERMIT ,t <br /> 1 2 Phone/E-mail 06(0 - V-4 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Buildingi ., t l)N� HEAT SOURCE: <br /> Proposed Use of Building VI,2-,.:/: <br /> VY e,(>6'-vc Gas • Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family ,X Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Or>, �. ��al� S� ��rxe <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 airs stems 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 Backflow preventer inside bld <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refri eration 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 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 compl <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 owner of this 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 /> '6�p /L-Al� <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />