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�ERMIT APPLICATIO <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: `��O �� �r` �^ e�� � PROPERTY TAX # P MIT <br />�f1 ��r <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER / , r /1 �L�i Phone/E-mail <br />, <br />Address � �b� 1 �Q\/(/'� � �,i/'GU' <br />APPLICANT: _ Owner _ Owner's Agent <br />CONTRACTOR � t� ��QP <br />Address ��J6� �� ��(/� � <br />TENANT BUSINESS NAME / <br />Contractor <br />BUILDING PERMIT APPLICATION <br />�. <br />City/State/Zip ��� �,rtv � � A -/ 8� 3 <br />or's Agent TBflBflt (must provide a letter of consent Irom ihe owner to do work in the space) <br />L& I Lic. # b Id CG/ / J COE Bus. Lic. # <br />Phone/Email � . � z3 <br />CONTACT FOR PERMIT �ar� �Uh � <br />So3'ZZ.(o"lz�s <br />Phone/E-mail �"(,Z{r�� �'/ �//�JG' • �' <br />CONTRACT PRICE OF WORK I .�� <br />Existing Use of Building .75 / HEAT SOURCE: <br />Proposed Use of Building �!� vl 1 Ii61� Gas Electric other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family �Commercial <br />Type of project: New _ Addition � Remodel _ Repair _ T.L _ Sign Sprinkler _Demolition_Chanqe of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />. . _ - _ � . ! <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New __Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ran e <br />Clothes d er <br />Ran e hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeration <br />I Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />... � . . � , � . _� _ -� GLG2�2 . <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash bas <br />Shower <br />Kitchen sink & dispi <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this applicalion and know the same to be irue and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with 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 lhis property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />--1 <br />Owner/Authorized Agent Signature <br />Date <br />(Revised 6/2012) <br />1 <br />� <br />