Laserfiche WebLink
I ERMIT APPLICATtO�t'�F <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 wuuw.everettwa.org <br /> SITE ADDRESS: �J j�� !j_,� _/ p tv�- ����Jj ,y�_A • PROPER�TA���D0�-DO�IOI P RMIT�# �— D <br /> �J i � Q.i Ql /i YY7T �-r <br /> LEGAL for new consiruction: Short Plat/subdivision Lot No. (attach copy of long legai description) <br /> OWNER �Q c {►`t!A O Z Phone/E-mail Z "�j S�k� (�!y � <br /> Address S��� �,(/+e%Pl �j��d• ��4 l,l V�� City/State2ip <br /> APPLICANt:_Owner �,,,Owner'S Ageflt _ContfaCtO� _COntrdCtorS AgBnt _Tenant(must provtde a lener ot consent from the ownerto do work in the space) <br /> CONTRACTOR State Lic.# City Bus.Lic.# <br /> ddress Phone/Email <br /> TENANT BUSI E S NAME CONTACT FOR PERMIT`a�r,e�� .�J�L_._^ <br /> ,�v <br /> PhonelE-maii 2oG 8�a c Zz� ` �A�WY'tM�2�J�.a� 'K�"f' <br /> BU/LD/NG PERM/T APPUCAT/OIV coNrRacT PRiCE oF wORK `�� <br /> Existing Use of Building ��� HEAT SOURCE <br /> Proposed Use of Buifding '�v�1�- G Electric Other <br /> Building type: �.,Single Family _buplex_Townhouse ,_Multi-Family _Commercial <br /> T e of ro'ect: New Addition Remodel Re air T.L Si n S rinkler Demolition Chan e of Use <br /> DESCRIP710N OF WORK(additionalspace provided on the back): ��{d G�,�-,Q d �Q��•�- �tl/h�(,l�JQ <br /> d.Nd t r. �� -�(X'/�7 IlGqf/ t�ir.d at�3 �a.� �KcS f��n � <br /> �' �'-� 9 <br /> MECHAN/CAL PEftM/T APPL/CAT/ON PLUMB/NG PERMIT APPLICAT/ON <br /> Type of Project: _New_Addn LC Alteration,_Repair Type of Project: _New Addn �Alteratton_Repair <br /> Show Number # of flxtures 5how Number # of fixtures <br /> A/C—air handtin units i Toilet <br /> ! Forced air s stems Bathtub <br /> Gas i in t Lavato wash basin <br /> 1 Water heater ti Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> [ Clothes d er t Clothes washer <br /> Ran e hood <br /> � Euhaust fan Sink service/bar/mo /etc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal • <br /> Boiler Drinkin Fountain <br /> Refri eration t Floor drain <br /> Woodstove Grease tra <br /> � Ductin Roof drains <br /> Other Medical Gas <br /> SPR/NKLER/SUPPRESS/ON SYSTEM Other: <br /> Number of Heads � Other: <br /> I hereby ceA�Yy thet I have read and examined this application and know the same to be true and carent.AA provisions of laws and ordinances goveming this type Of work will be compt <br /> with whedier spedfied hereln or not.The granting of a permk dces not presume to gnre authmRy to violate or cancel tt�e provisbn of any other state or local law regulatlng construction <br /> Thet I am author¢ed by the owner of fh property to pertortn the wwlc for which appP�catlon�made and�oompy wNh the State Contractors Law 7827 RCW and 296.200A WAC. <br /> �c�t.�, Za D�f Zot� <br /> OwnerlAuthortzed Agent Signature Date (Rev/sed 9/2014) <br /> `I� <br />