Laserfiche WebLink
OPERMIT APPLICATIOi%4 <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 /> Fe ( _("(: --� S }--- UO 4 Z Do 0 e) '!'�l p 'J <br /> LEGAL for new construction: Short Plat/subdivis <br /> ion Lot No. 7 (attach copyoflong legal description) <br /> OWNER �G // �iv���/t�C, //C/7/7ll i'�� Phone/E-mail �G ���s cJ ,�/ Z ZZi <br /> Address fPC7�dX I 7 City/State/Zip <br /> APPLICANT:,Owner _Owner's Agent _Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> s� L1Q,� <br /> CONTRACTOR N!/�/9 State Lic.#A N 0 L<� I`1 I C( 1— City Bus. Lic.42-4 <br /> Address I Phone/Email <br /> TENANT BUSINESS a <br /> �NAME CONTACT FOR PERMIT.<71 <br /> 9Z4 `n1d r' ' `� Phone/E-mail 2�2 S 7 61,5� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building J`F/� HEAT SOURCE: <br /> Proposed Use of Building �� Gas ' Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type ofproject: New Addition X Remodel Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn X 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 p mp Backflow preventer inside bldg) <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 comp) <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 aut zed by the�;Ttnisrty 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 /> -J <br /> S <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />