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• • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERJDEMOLITION <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# IT <br /> - IC, � ,�l � C�2(�(� — <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWINE �y„ � ' f,,,, Phone/E-mail Z - - "� �\ <br /> Address �Z ' �y \ �'2S City/State/Zip .� ^ � T �� ' <br /> APF'LICANT:_Owner _Owner's Agent �Contractor _Contractor�S A9@flt _TEI12flt(must provide a letter of consent from the owner to do work in the space) <br /> � - <br /> CONTRACTOR � = `\:..,.ki� , State Lic.#�� -�� � °� �_ ;'��i�'"-City Bus. Lic.# �I" � <br /> Address � �.'�)C� _ - '�, , ' � � ` �':Z,' Phone/Email �L�- �'��,.�;'%' --C �2,1.� <br /> TENANT BUSINESS NAME C NTACT FOR PERMIT `.-� S�• _ �� �i, <br /> . <br /> 1 � �� � .I'\3' <br /> �-C.� `(�l\��"�. t�►:)�'�''�`���'� i�' ivXk''' "-�-�U j�L�Yvl�l.iS2.�w;;. <br /> � ' Z,� �t��� (_;� Phone/E-maif � <br /> i <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WO K� � � <br /> Existing Use of Building�(1�G` ��.,(:,'�.Ll t,r-���� �� HEAT SOURCE: ;' <br /> Proposed Use of Building .`�G�Yo�. , 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 molition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back)��;:�-t-�,�'�,;�,��� 1 �,1L�� 5�� �� c���5..;�,�j_ <br /> �;,%r,� C �c�r��,, C ti.�:.-, ; ;�ej �;;>��� �, � . �ar <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 5how Number # of fixfures <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 I Kitchen sink&dis osal <br /> ' Gas ran e � Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink service/bar/mo /etc. <br /> Heat um Backflow reventer inside bld <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 /> SPRINKLER/ SUPPRESSION SYSTEM j Other: <br /> Number of Heads � Other: <br /> I herf:by certify that I 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 /> wfth whether specified 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 authorized by the owner of this property to perfortn the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � <br /> 'z� �� , V �7 -2! -1��7 ���`� <br /> O rier/Authorized gent Signature ' Date ( � � � (Revised 4/2015) <br /> \ � <br />