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• • <br />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 vwvw.everettwa.org <br />_ � 5 �I✓ <br />SITE AD RESS�'�^ PROPERTY TAX # P # <br />.� ✓Lo � �� � • � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />^ � ' Phone/E-mail <br />OWNER C' �� G,Lv� <br />Address 1,��- ' �;h� , � � City/State/Zip � � � � � I ��l'� �. � j i,., � �tiC:. � D � % <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant (m�5t Pro��de a iener or oo�sem r�om tne oWr,er io do work �r, �ne SPa�e> <br />CONTRACTOR � (� (,�C.� State Lic. # % � -N �-L � City Bus. Lic. # � ��%f � <br />Address� �� �7j ' ��j �%l' i? I iv��� �, '� Phone/Email �? � CL C, t- c` Li 5yt.�;,C,� ' i0 <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />M�l(hfe�c'tj��c�_ iLri i_ ��"�'�—_ <br />�� ►ei�. CcI C�f,cP�.- n -�-c� - 3 — 2 2 <br />- l f IV? I�� Phone/E-mail �� � �' <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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 (additiona! space provided on the back) : <br />� j <br />�t�c' � 1 I� l l � l.C_i. :_.�. i; i I^-- <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 Fxfures <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 />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 />j Boiler Drinkin Fountain <br />Refri eration Floor drain <br />Woodstove Grease tra <br />Ductin Roof drains <br />Other Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM other: <br />Number of Heads 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 this rype of work will be compl <br />with whether specifed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other stale or local law regulating construction <br />That I am authorized by the owner of this property to perform Ihe work forwhich appiication is made and I comply with the State Contractors Law 1827 RCW and 296.200A WAC. <br />--������ �� � ,3 � �y� , �- <br />Owner/Authorized Agent Signature Date (Revised 9/2014) <br />