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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 />E ADDRESS: PROPERTY TAX # PERMIT # <br />�a� r����-,a � r�f�4s/4f)I �7_Z�n �� �_ �Z-� <br />for new construction: ShoR Plat/subdivision <br />ER <br />SI <br />Address �p�pZ KV(�e�1/" �Yv� <br />APPLICANT: _ Owner �Owner's Agent �Contracior <br />CONTRACTOR 1 VprG� \L S�%'V (�Q s, <br />Address q�plg 1,`���� aV �! V -�c <br />TENANT BUSINESS NAME <br />BUILDING PERMIT APPLICATION <br />_Lot No.� (attach copy of long legal description) <br />Phone/E-mail <br />ity/State/Zip ��%C��� VV (Z, � gZ� � <br />COntfaCtOf'S A9@f1t _ T@flaflt (must provide a letter ofconsent from the owner lo do work in the space) <br />�� L& I Lic. # N �� D� �� �g� � COE Bus. Lic. # <br />� $I �?j Phone/Email �%�p �j � �,.7 70 <br />CONTACT FOR PERMIT �pU i � <br />�o� �s'�ia6l <br />Phone/E-mail (_,pi/j e, /1,�ya(�p�o �f y jce S.c.ew� <br />CONTRACT PRICE OF WORK <br />Existing Use of Building SF � HEAT SOURCE: <br />Proposed Use of Building /VO �LGFLIGI �- 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 on the back) : <br />�l r� G�,Q,tMQQfL �- �QD� r'� T�,E7�E�lT' s� 5 Tt1M �- f Ui �"ilr' 1 �(�' VI�C'�� 1• <br />Jf <br />�dD �' Gz r� o � -�i �''� c�a.►v�cz.� � , <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of /ixiures <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Kange nooc <br />Exhaustfan <br />Heat pump <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />( Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />I Bathtub <br />Shower <br />Kitchen sink & disp <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/barlm <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 thal I have read and examined this application and know the same to be true and coRect. All provisions of laws and ordinances goveming this type of work will be complied <br />wilh whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel lhe provision of any other state or local law regulating construction <br />That I am t orized by the owner of this 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 />�2 � �y <br />O e/Au horized Agent Signature Date (Revised 6/2012) <br />