Laserfiche WebLink
CITE( OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> PERMI-# l I <br /> SITE ADDRESS: <br /> ' O <br /> If .= (attach copy of long legal description) <br /> LEGAL for new construction: Short <br /> `Plat/s�u�bd�ivisi-o7n� 2 2 <br /> OWNER �/�✓//��L !�/�"'/�i/` PfionelE-ma' 3� �;/ '- ✓77 �d"��7ZZ <br /> f City/StafelZip '� <br /> Address <br /> APPLICANT•_Owner _Owner'sAg�egnt ,Contractor _.Contractor's Agent —Tenant(mustprovideale�terof�onsentrromtr,eownertodoworkinmespace) <br /> CONTRACTOR G'Je iG v-`, 5w Lyelf 6�- p e� State Lic.#e r- ®�� ®` City Bus. Lia#001 j <br /> (� ( - 25: 3 I r <br /> Address t' �`� "�(� Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> VeM, <br /> Phone/E-mail {p <br /> BURLDONG PERMIT APPLDO„ROM CONTRACT PRICE OF WOR <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas-K Electric 4other_ <br /> Building type: ii� Single Family _.Duplex Townhouse _Multi-Family _Commercial <br /> Type of project: -___New _Addition _Remodel. .Repai — I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION R&.WORK,ladditional space provided on the back <br /> � <br /> MECHANICAL PERMIT APPLICATION <br /> Type <br /> 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 i Toilet <br /> Forced air systems Bathtub <br /> I 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(se Vice/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 I � 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 complied <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 y the owner ofthis properl 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 /> (Revised 3/2013) <br /> Owner/Authorized Agent Signature <br /> Date <br />