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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br />CITY OF EVERETT RERMIT SERVICES <br />3200 Cedar St., Evereft, WA 98201 425-257-8810 FAX 425-257-8857 www.e�erettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ITE ADQRESS: PROPERTY TAX q P�j MI.T�} <br />°1�F? ( �1d�Ss0�: ��.,,�� E�lcr-�t� iF ,':r✓A . 4"�� `it'J� — C� � <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legai description) <br />���:;tstl,°�6f� SC�icoL �<_�4�:;�i <br />9�;01 5«a�.��'a�.;� <br />E��R��-,����. �s�a� <br />APPLICANT: _ Owner _ Owner's Agent � Contractor _ Contractor'S Agent _ TE�ef1t (must provide a letter ol consent hom the ovmer to do worVc in �he space) <br />CONTRACTOR ������ &RO44'�r�F! �QQFIP%u L&ILiC.# 5Q� o�.'OO COEBUS.L'IC.# <br />aadress s��.�- �'�`Pf�t�i� �wY- ���yT'; �/j�, Phone/Email 2�3 �3a���'{ <br />TENANT BUSINESS NAME CONTACT FOR PERMIT �� R�� r�c.� 1 N N o N 253 63 8T � 4 y <br />i`��s��"��'�r� ��".��',t7� �T��r!aL�-� <br />Phone/E-maii b ���t c F3+ m e�@ r�j � o�� � t <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � 44 t, Do0 , t�D <br />Existing Use of Building <br />HEAT SOU <br />Proposed Use of Building � Gas_ Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />�pe of project: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br />DESCRIPTIONOFWORK(additionalspaceprovidedontheback): �,�;�„a,�� `�N�.,,w,�;T�P, COp1aCx ►�1��A4,RE����E Ex�Sf+NC� <br />EP'�7i'ci j�s:,:j� fres,r��.;�A�l�� l't� Fte1.s'� E:`FG�1�:(x EY.tSq�NG Gt3lj,' E.��i I�ISU�..AT741� R7�. (�i���ER,� �=Erl UEPISP�C{{ ��K�� <br />C�.VERz%::.s.i'.�,'tii }rS b�i�z`5�`a'�J'P41.�vk�i��l�ta.!;.1 f4�:GC1-�t fiT C:i(��^S.ToitC?a f���4!�' � 1�'�ErSS S�S ��JJF 1F4CP:h�}�1(k�� <br />�lr1.0 4':"'��: ;'4t+.:i;`!1fs. i�,7Si(klml �i��✓ COP�tS^� Yil� ��aL , t;,!`,-�:�1.1NG 'i� �i�� ROOF �i R13S F0� 'ri�i(,G COki?ROIS <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn ^Alteration _Repair <br />Show Number (#) of fixtures <br />i A!C — air handiing units <br />Forced air systems <br />Gas piping <br />Water heater <br />' Gas firepiace <br />Gas range <br />Clothes dryer <br />' Range hood <br />Exhaust fan <br />I Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />i Ducting <br />Other <br />SPRINKLER / SllPPRESSION SYSTEM <br />i Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />! Shower <br />Kitchen sink & disposal <br />Dishwasher <br />; Clothes washer <br />Water heater <br />� Sink (service/badmopletc.) <br />Backflow preventer <br />• Urinal <br />� Drinking Fountain <br />Floor drain <br />; Grease trap <br />Roof drains <br />Medicai Gas <br />Other: <br />I hereby cerli(y that I have read and examined this application and know the same to be We and wrrect. All provisions of laws and ordinances goveming this rype of work will ba compUed <br />with whether specif�ed herein or not The granling of a permit does not presume to give authority to v'wlate or cancel the provision of any other state or bcal law regulatlng consWcfion <br />That I am authonzed by the owner of this property fo perfoRn lhe work for which application is made and I comply with tha State ConVactors Law 1827 RCW and 296.200A WAC. <br />� .,� ,;;�,,���.:�h�� 3f 2 l � � <br />OwnerlAuthorized Agent Signature Date <br />(Revised 6/2012) <br />� �Z <br />