Laserfiche WebLink
��►,. �' <br /> PERMIT APPLICATION <br /> E�UILDINGlMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION , <br /> ClTY OF EVERETT RERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SI EADDR SS: PROPERTYTAX# p <br /> � Y �201 � , � <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER PhonelE-mail <br /> Address City/State/Zip <br /> APPLICRNT:_Owne� _Owner's Agent Y CO�ff8Cf0� _COf1ff8Cf0f'S Ag2f1t _TEft8f1}(must provide a letterof consent from the ownerto do work in the space) <br /> 7t <br /> CONTRACTOR � State Lic.# �w City Bus.Lic.# <br /> Address � Phone/Email <br /> TENANT USINESS NAME NTACT FOR PERMIT , <br /> L-��lo �rlsfii�e, ��10�� <br /> Phone/E-mail - • r .CD� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_�4�� pp <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 /> T pe of pro'ect: New Addition Remodel Repair T.I. Si n Sprinkier Demolition Chan e of Use <br /> DESGRIPTION OF WORK(additional space provided on the back): � <br /> �, G� ��en�+ �pr'I��=�e�' 1����5 <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 fixfures Show Number(#)of fixtures ' <br /> A/C—air handlin units � Toilet � �- • <br /> � Forced air s stems <br /> � Gas i in � Bathtub � <br /> � Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kifchen sink&dis osal <br /> � Gas ran e � Dishwasher ' <br /> � Clothes d er � Clothes washer <br /> Ran e hood � Water fieater <br /> Exhaust fan � Sink service/baNmo /etc. ! <br /> Heat um � Backflow reventer inside bld <br /> Unif heater Urinal <br /> Boiler � Drinkin Fountain � <br /> � Refri eration Floor drain � <br /> Woodstove Grease fra <br /> Ductin Roof drains � <br /> •: • � Other � Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM � Other: <br /> � Number of Heads Other: I <br /> L hereby certify that t 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 comp <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel fhe provision of any other state or local law regulating construction <br /> That I thorized by the �vner of this pro o p rForm the work forwhich application is made and i comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> Gl. � .�g ,�.��w�=-, <br /> Owner/ Yhorized gent Signature Date �dF �/ <br /> ;€ �� I (Revised 4/2015) <br /> '`-�._____..,.,....^". , <br />