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� <br />� <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 />SITE ADDRESS: PROPERTY TAX 4i PERMIT # <br />��t �- �,,�.� i�;�. ov �����+3��c:yc�c � i 3G5 - <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER T:iu e.� �r:'L1fe 1—t i.:_i,a,';E� Phone/E-mail �,.� � � t!� �14����r�4 i�'�..�i 'L �,(:� `+ l 1 <br />-2 <br />� <br />City/State/Zip i vp��('r �,,�;�r � � <br />APPLICAN i: �Owner _ Owner's Agent _ Contractor _ Contractor�S Aj2tlt _ T0f18f1t (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR ��•�.As�Fz 'vu���'=�� State Lic. # MP�► E3�- C(p3 5� City Bus. Lic. # <br />Address ���' S1����'���L `�� • N`� ���L� �Ni� ��..�}F. Phone/Email LS3 —S�'3 � 3c�t� <br />TENANT BUSINESS NAME CONTACT FOR PEF:MIT <br />���C, ... � � � � ... 5 �1 �, � <br />Phone/E-mail �bbles pn«�� i�"f ����"� J <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �. l0 ��'rs�0 .. c�0 <br />Existing Use of Building 5 �� � �- � t?�� �� ��%M E HEAT SOURCE: <br />Proposed Use of Building �AM E R5 h3pU� Gas� Electric_ Other <br />Building 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 or, the back) : Mov � P'� �,C +����� N� RD a iN l� gjf►T N�t=h�5 � <br />� 1�� �� S�', ,�1 � C� v.�� �-Q',A.u: v'� 1� �., �.� V•.'v.� L'"� l% (, t1� i f�t 1� r`; � v? � 1`�T F � L V M� 1 N 1�' <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 />I Gas oipina <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Unit heater <br />Boiler <br />I KetngeraUon <br />; Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� � Toilet <br />� � � Bathtub <br />� I Lavatorv (wash basiN <br />Kitchen sink & disp <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Drinking Fou <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 application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied � <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 state or local law regulating conslruction � � <br />That I am authorized 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 296.200A WAC. <br />� y�� �� � �C�� �'7 1��:�-- <br />r_......-�-, ,� �,�( , / f� <br />� ��-=•��irt�-�- ;� / / �c-� �C' v'�xi� `� � �� : � �V� <br />Owner/Authorized Agent Signature Date � v��Revised 3/2013)f— <br />