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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 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: PROPERTY TAX # PE IT # <br />r��r�� r�� 2^►�i ' �' o-�� ��u �s l 6 <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER (_�(ji;' �, Phone/E-mail �/z j-- 3 - Z Y4 2- <br />Address (, � o s% lYl ��' F-' 1 L l. (�_� � /�,� w� City/State/Zip �� V k. � f� 7 �..,.$ `'�l �S � �:- 3 <br />APPLICANT: _ Owner _ Ov�mer's Agent /"Contractor _ Contractor's Agent _ Tenant (must provide a ier.er of consentfrom me owner ro do work in me space) <br />CONTRACTOR �ti� ���b) StY� L& I Lic. # flil C/t�/L CG `�`11_['�„ COE Bus. Lic. #/ i x ' <br />Address �-'C � ��`( � �� � S L�f"I 1.�,� f. Phone/Email Z t%� 7( Z 33 �� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />`, ; � ,�j A; `v�Q�i; c.� 7 t��; � , <br />/` � / <br />l%�v j��$ Phone/E-mail 7,�'31 -b�-i�7 C�Gsu�'7 ��LiL �C���Pjh' .. CC' <br />BUfLDlNG PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric Other_ <br />Buiiding type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ 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) : ,, . � <br />i_�,L S 7/'� L L la� t i �t N J E klr rfiud'; <)u �T 1�-c:%/z � c�� �-� �r m t7zC' ��`��- i�Iz y�r=- . <br />7;�- iii � �x�6�r/�v � 6�'rs" ��' �7'z �v�7 ll�l� �?� /�cc� D�Ye� - <br />�.1; L v t.�'t'tL:- �?C( S; r1�1 � /� u2 T�rv �. , <br />MECHANICAL PERMiT AQPLICATION 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 (#J of fixtures <br />� A/C — air handling units Toilet <br />� Forced air systems j Bathtub <br />� Gas piping j Lavatory (wash basin) <br />i Water heater I Shower <br />� Gas freplace � Kitchen sink & disposal <br />I Gas range � Dishwasher <br />j i: Clothes dryer ('�miy1L�7.t' I•qZ � Clothes washer <br />( Range hood Water heater <br />Exhaust fan � Sink (service/bar/mop/etc.) <br />Heat pump I Backflow preventer <br />Unit heater Urinal <br />Boiler � Drinking Fountain <br />I Refrigeration I Floor drain <br />� Woodstove I Grease trap <br />{ Ducting ; Roof drains <br />E Other I Niedical Gas <br />SPRiNKLER / SUPPRESSlON SYSTEM � other: <br />� Number of Heads � Other: <br />I hereby certiFj 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 complied <br />with whether specifed herein or noL The granting of a permit does not presume to give authority to violate cr cancel the provision of any other state or local law regulating construction <br />That I am autM rized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />S J ;�— 1 <br />,7/Z � � I Z <br />Owner/Authorized Agent Sighai�r D te / (Ravised 6/2012) � <br />