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PERMIT APPLICATION <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> & m <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER �TEGSINI� �( 2&VqT Phone/E-mail JZ-! -25t- 269Y <br /> Address City/State/Zip 1✓ t W4 <br /> CONTRACTOR ��(���-�c� (l�l� 6A U MM L&I Lic.# �/ ��`a S 415-251 <br /> Z ZG I LL)t;� c>�'�5-5- <br /> Address <br /> 5 <br /> Address t AC I. Lc .*�' j 4 Phone/Email ` 1 -252-3it� <br /> "� 2� v c irGl�-"Tl"fel `��ZcI <br /> TENANT BUSINESS NAME l CONTACT FOR PERMIT <br /> � CfiJi/U T 1 �f Phone/E-magP41tk(&- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> �{ <br /> Existing Use of Building 1"o e-49 X e- HEAT SOURCE: <br /> Proposed Use of Building Pq® C44^k'z Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family k Commercial <br /> Type of project: _New _Addition _Remodel -Repair_T.I._Sign_Sprinkler Demolition Change of Use <br /> Description of Work(additional space provided on the back): ©v! is /1 � �t�� �Z(`c't' 7 /v iy t 1J <br /> Have you started working without a permit? YES NO <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 Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing <br /> this type of work will be complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of any other state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to pe the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> (,am utho ' gent Signature Date (Revised 2/2011) <br /> �lz <br />