Laserfiche WebLink
PERMIT APPL�I�A, N <br /> BUILDING/MECHANICAL/PLUMBIN /SIG /SPRINKLE DEMOLITION <br /> CITY OF EVERETT P RMIT S VICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-881 FAX 425- -8 www.everettwa.org <br /> SITE ADDRESS: PROPERTYTAX# E T � <br /> l,5 � h�.af�f�-�� 1�l�.uJ 1�2-- -- <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER �,�- �� ""'9' Phone/E-mail � '"'"�� <br /> Address City/State/Zip � � � <br /> APPLICANT:_Owner _Owner's Agent �Contractor _Contractor's Agent _Tenans_�m�tare��.de`ner or�on5er,t rrom cne ow�,e�io ao rk:uilfi"' a�>t � <br /> � <br /> CONTRACTOR '� T State ' .# •1;r�sw� b City Bus. ic.# ��'L91�j � <br /> Address � ����1� �""� _ _ � <br /> �l'D ��OI.1� A� � �A tJ T� � lEmail � -�`� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT V <br /> �l/C.R�� �nl�I f.9�� k',.��J C� ��3-Z.��-7��Co <br /> 'TI��2ot`t L�vrS <br /> Phone/E-mail �* � 5 �4.,nn ,GS.n/1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � ��:rs��� <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 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 /> i�'B V�t t�i� T(.�t o 1�0� Sy ST�i'�^ �b�e>1z�5 ,c��D c�N t�' p�,� ��'ST�r�. ��p►�.1C� Ftr1'e�� <br /> �1iD F��� L;11s.nn�-��L� �y �r i R-,�, . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteretion_Repair <br /> Show Num6er # of fixtures Show Number # of fixtures <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 /> I Clothes d er Clothes washer <br /> Ran e hood ; Water heater <br /> Exhaust fan Sink servicelbar/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 /> SPRIN�LER / SUPPRESSION SYSTEM I Other: <br /> � � I Number of Heads Other: <br /> I her y certify th I have rea and examined this applicalion and know the same to be lrue and correct.All provisions of laws and ordinances goveming this type of work will be comp <br /> wiih wh ecified herei or not.The granfing of a permit does not presume to give authority lo violate or cancel the provision of any other sfate or local law regulating conslruction <br /> That I am auth�y lliJ owner of this property to perform the work for which application is made and I comply with the State Con aclors Law 18.27 RCW an�96.200A WAC. <br /> �� - — �`�� e� � <br /> Owner/Authoriz gent Signature Date (Revised 9/2014) <br /> b'7/ <br />