Laserfiche WebLink
'ERMIT APPLICATI� <br /> BUILDING/MECHANICQ►L/PLUMBING/SIGN/SPRItVf�CLER/DEMOLITION <br /> CITY OF' EVERETT PERMIT SERVIC�� <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everetlwa.org <br /> SITE ADDRESS��� � � � � �Z PROPERTY TAX# P � hT � � <br /> � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER `,� �C�f�,l_ �� L—CST1ft��'— PhonelE-mail ��LSJ 25 Z—� 4`�� <br /> Address City/5tate(Zip �c,J(�'��C�i- (;(..Y� , ��z�� <br /> APPLICANT:_Owner _Owner's Agent �Contractor _Contractor�S Ag�llt _T0f18f1f(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR � % 5 2�� J � % (� — ✓'t� State Lic.# u„(,(Z(ps (�z.ZC`��— City Bus. Lic.#(' S <br /> Address Z�Z� ��C� L Phone/Ema` � ' �ZSz -�l/ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �� ����-���,�t�JC��C`O� <br /> � <br /> ����CS tjfl r-�lL (�� �„��-�-' <br /> Phone/E-mail � "�5�- �(( <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WOR �2 � <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family '�Commercial <br /> Type of project: New _Addition _Remodel _Repair T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ���- ��� � �t-�,�s��� ��,u� � r—�p G.2�CCS `� i�Jc �=N�.�cS E=�%� t�x�� <br /> �%�-N� �J�r�� <br /> MECNANICAL �ERR717' A��LICA'T00le� 6'LI.DM�IBdG PEl3Nl13' �4PP�ICA'�IOId <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration^Repair <br /> Show Number(#)of fixfures Show Number(#)of fixfures <br /> � A/C—air handling units ; Toilet <br /> Forced air systems I Bathtub <br /> Gas piping � Lavatory(wash basin) <br /> � Water heater � Shower <br /> j Gas fireplace � Kitchen sink&disposal <br /> � Gas range I �ishwasher <br /> � Clothes dryer � Clothes washer <br /> Range hood i Water heater <br /> � Exhaust fan � Sink(service/bar/mop/etc.) <br /> Heat pump � Backflow preventer <br /> � Unit heater I Urinal <br /> � Boiler j Drinking Fountain <br /> � Refrigeration � Floor drain <br /> Woodstove � Grease trap <br /> � Ducting � Roof drains <br /> � Other j Medical Gas <br /> SPR NKLER / SUPPRESSION SYSTEM j Other: <br /> INumber of Heads � Other: <br /> I hereby certify that I have read and examined ihis applicafion and know the same to be true and correcl.All provisions of laws and ordinances goveming this type of work will be complied <br /> with whether specified erein or not.The gr ting 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 autho zed the owner of t is operty to erform the work for which application is made and I compiy with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> � � � ; <br /> 1.,� �� ( Z l� <br /> OwnerlAut orized Agent Signature Date (Revised 3/2013) <br /> �lz <br />