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• � <br />PERMIT APPLICATIO�i <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 />TE <br />� <br />dress <br />�� <br />for new construction: Short Plat/subdivisi <br />� <br />`� l ���_ �%���UJ� <br />PROPERTY TAX # PE MIT # <br />J[��';�� :�SZ����7c� �i� <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail �,� rj — � p� — ,�j � � � <br />City/State/Zip % �/"�' /'�✓ <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�S A9ellf _ T2f18f1Y (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR p�7�' � ifl (�� -�� State Lic. # City Bus. Lic. # <br />Address Phone/Email <br />TENANT BUSINESS NAME CONTACT FOR PERMIT C(s <br />l�l� A- �/�5-y�:�-"�a ��'� -l� � <br />. Phone/E-mail c�C?l Cl/l c7 �'��`f ��� � E���i•l� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK `� (-1,�' t' <br />Existing Use of Building �''�S � Qf'✓� fl �f� HEAT SOURCE:.- <br />Proposed Use of Building i�'S � C�f'r I �i Gas Electric ✓ Other <br />Building type: _ Single Family _ Dupl�e�x �Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition v Remodel Repair T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : L `� 1 <br />Ci��� ,� �a�c-( •�'X ��� f-�i�c �� c-f {� a S f�/1 u� f�C' c�T .� �� i/��/ %�J �L� i/� <br />I c� ✓r� ��'f a�� s h�� � 1-�4- ,�T�ic .S% �rr q,�.> t,-ve i �, �. °� Cc P P rt��}C I, 1 P� u���5 <br />'(X��' Sc� u.ure ���� o,,, eX��. l l�r v��-- <br />MECHANICAL PERMIT A PLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />5how Number (#) of fixtures <br />i A/C — air handling units <br />( Forced air systems <br />Gas piping <br />� Water heater <br />I Gas fireplace <br />Gas range <br />� Clothes dryer <br />� Range hood <br />Exhaust fan <br />Heat pump <br />_� Unit heater <br />Boiler <br />i Refrigeration <br />� Woodstove <br />i Ducting <br />I Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />� Toilet <br />Bathtub <br />i Lavatorv (wash basinl <br />Shower <br />Kitchen sink & dispo <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mo <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 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 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 autho ized by the owner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�' 'l�- <br />� d )� II f <br />Ow Au orized Agent Signature Date (Revised 3/2013) <br />