Laserfiche WebLink
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.everettwa.org <br /> SITE ADDRESS: _tot Ot ,�r� M e Se PROPERTY TAX# a PE ( l • <br /> LEGAL for new construction: Short Plat/subdivision 1 1 1 tt1l1* .S Lot No.S U (attach copy of long legal description) <br /> OWNER 9 jlAth OC ( (,, !5 I Phone/E-mail 425 cis-3 Zed) <br /> Address 12D SvJ 2 i Q Az(-1 l I \� *l�' DD City/State/Zip v.e(-e+# v r Gt ZS 2.04 <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 i �(A Med�`,nO' m�j /��� Vf,V,[e 1,1 IIfC-( State <br /> �tLic.# � V�j( P1 L' I�;L�ity Bus.Lic.# <br /> Address i�2 P((c�t)t'4 (W Q.r 5 k 0 t Slot( (S I44ii vvf. Phone/Email Lt 26 3-1 5 100 <br /> TENANT B-- ESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail tri ♦ 01 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $ i/7-(X) <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): �1 C(L° dCQ CO <br /> 1)/10((11s' — US° 1 re y pp(e7 <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 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 /> 1 I - 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 spec'red 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 au zed by t.e 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 /> / , <br /> /t/IS' /VIII& <br /> Owner/Authorized Agent Signa Date (Revised 9/2014) <br /> 2 <br />