Laserfiche WebLink
PERMIT APPLICATION 1pGe, 1 1,-� - d,0--,�Z <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# RMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER &-!T11 C ice. IZOLk-) _L. Phone/E-mail t�, , – • <br /> Address 'G Z- n-r PL City/State/Zip SAmm - 1 i v\iA <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 /> CONTRACTOR P1CJC I VLA n1G L&I Lic.# M ° OE Bus.Lic.# <br /> Address 14 b i s OJAAlim k , T 20C-- c )L Phone/Email-- (L"D exo s `l u. o <br /> TENANT BUSINESS NAME CO ACT FOR RMIT <br /> E-�ScL ty F�Un� 2.:�L <br /> /CPhone/E-mail "j S Za=N Fb L-1� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK S ' <br /> Existing Use of Building S nZ HEAT SOURCE: <br /> Proposed Use of Building �OFLC)C I Gas_ Electric Y�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�I F'� SAMA cr �,E P!�I IZ. i�' E.PL K�cE pias► o-�D RooF= w/ P4– –nZUSSC–S @ L)P 12-(Z R Oc.>,Z. <br /> tu N cu—) iNTe.ZAo)Z- rIN ISH E.S , ri cL r lLr-5 L UP 1�« rcooR <br /> l MN11y qLk) -. CF-*AVCZtr SiL'f-o 7�>vW-;r--l)C. <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 air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace 1 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 <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 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 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 /> Owner/Aut rze Agent Signature Date (Revised 612012) 1 l <br /> L <br /> i <br /> r <br />