Laserfiche WebLink
� �ERMIT APPLICATION y <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# P RMIT# <br /> 30�3 w• CNStrta �D F�re� t3i.DG -3e � � � .' Q� <br /> LEGAL for new construction: Short Plat/subd(v(sion Lot No. (attach copy of long legal descdptton) <br /> OWNER �b 1 PhonelE-mafl <br /> Address P�4 0�. �1 b"( M�S �H-l3 c�rirsteteizip S��, 9b 1 - 2.�.0'? <br /> APPLICANT:�„Owner _Ownet's Agent _Contractor _Contractors Agent ,.,_T817a�t(muat proNde a letter of conaent trom the owner to do work in the spece) ! <br /> CONTRACTOR ��`�?1•�� State Lic.# Ci Bus.Lic.# <br /> Address Phone/Email � <br /> TENANT BUSINESS NAME CONGTACT FOR PEcReMIT 6 <br /> S`�� �I�iF� �J�����O��a <br /> - Phone�-ma�� ,SE,FPERY•G. DRkY�,K � gDEI�Cs. COM <br /> BUILDING PERMMT APPLICATION coNTrucT PRlce oF woRK $'��°� . <br /> Existing Use of Building P�Fb HEAT SOURCE: <br /> Proposed Use of 8uilding �''1�� Gas_: Etectric Other_ <br /> Building rype: _,Single Family _Dupiex_Townhouse _Multi-Family ZC Commercial � <br /> T e of ro'ect: ._New Addition Remodel Re air T.I. • S( n S rinkler Demolition_Chan e of Use <br /> DESCRIPTION OF WORK(addiHonal space provlded on the back): , ', <br /> rNS�r�c.� C1) S��Tto� c� �'Au�r RA�K.• . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION I <br /> Type ot ProJect: _New_Addn _„Alteration_Repair Type ot Project: _New_Addn Alteration_Repair ' <br /> Show Number(#)of f)xtures Show Number(#)of fixtures I <br /> A/C—air handlin units Toilet I <br /> Forced air s stems Bathtub , <br /> Gas f in Lavato wash basin) <br /> Water heater ' Shower � <br /> Gas fireplace Kitchen sink&dis osal I <br /> Gas ran e - Dishwasher � <br /> Clothes dryer Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> HeaC ump Backflow reventer i <br /> • � Unit heater _ Urinal � <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease tra I <br /> Duetin 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 applicatfon and know the sama to be true and cortect.All provisions of laws and ordinances goveming thfs type oi work will be complied <br /> with whether specifted herein or not.The granting ot a pertnit does not presume to give authorNy to violate or cancel the provision of any other atate or local law regulating construction <br /> That 1 am authorized by the owner of this property to pertorm the work for which application is made and I comply with the State Conireetors Law 18.27 RCW and 296.200A WAC. f <br /> � <br /> 1 <br /> .� �a �d 1�' <br /> Ownerl o rzed Agent Sig ture Date (Revised 3/2013) <br />