Laserfiche WebLink
� � <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.everetiwa.org <br /> SITE ADDRESS:��/'.�I� '� ) Pl�OPERTY q„ �� , ` P T <br /> IISLG l/��l�IV1(f�r ����. � 'j �� �l.)�% �.i <br /> LEGAL for new construction: Short Plabsu division Lot No. (attach copy of long legal description) <br /> � � <br /> OWNER ` ,(� � �j�y'1 � ` ;Y�� Phone/E-mail � � �' —���" <br /> Address ���" �((f�1yl'�� � � City/State/Zip �'�" � �� �����4� <br /> APPLICANT:_Owner _ wner's Agent ,�Contractor _Contractor'S A9Etlt _T@fl8flt(must provide a letter of consent from the ownert 5 ace> <br /> CONTRACTOR , -�/� i � �� " ��'r1� _ State Lic.# ����.:J',� v���' City Bus. �c.#��C�� <br /> ' � '� - <br /> � I �r, �� 7 -- <br /> Address �� � �(,y S fi S SU I�L ��l:L��:�1 ��'�-'�� Phone/Email (� ��""�—j 'j � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �`o`"��� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: �Single Family _Duplex_Townhouse _Muiti-Family _Commercial <br /> T e of ro�ect: New Addition Remodel � Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> �� r - <br /> 1���ccC!�� -����-+�C, "���=t��.. w'4�- `r'-�."`' <br /> �� <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£xtures Show Number(# of fiactures <br /> A/C—air handlin units Toilet <br /> ! Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan ' Sink service/bar/mo /etc. <br /> Heat um ' Backflow reventer <br /> Unit heater ' Urinal <br /> Boiler ' Drinkin Fountain <br /> ' Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin 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 goveming this type of work will be compi <br /> with whel�er specified here or not. e gr3�ting�f a p md does not presume to give authonty to violate or cancel the provision of any other state or local law regulating construction <br /> t I a authory�ed by t e wner f is rto rm the work for which appli tion is made and I comply with the S[ate Contractors Law 1827 RCW and 296.200A WAC. <br /> � 1 <br /> , <br /> ,a � /� , � �- <br /> viln�r/Authori ed Ag t Si na Date (Revised 9/2014) <br />