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� <br />C� <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: PROPERTY TAX ii PER T# <br />Gl � Z ¢- 5 t�y 2e� �I i> 2 � (�;; � r: `:_�?_ c=T ' �4 I c�c►cx � t S�%O �� � � % .�(n ' �O <br />LEGAL for new construction: Short Plat/subdivisio <br />OWNER Gf cy�IU�'�,�'j� � V21� v�1G'rJ <br />Address � (pZ � S (f ��(�.�p N � � (V �- <br />CONTRACTOR <br />ress <br />Lot No. (attach copy of long legal description) <br />d�i C�l `.)�C.) Phone/E-mail 3 C�C? "� i�l� - l I �7 % CN'T "�IC� -� b,�� "� <br />City/State/Zip L-l/i_�L-�-Z%� v4l/'1 C�� Z U��- <br />L & I Lic. # <br />Phone/Email <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />� J l) � l� L t> l�1 j� � <br />'3 i.;�'� � 2c� S- Z"7 � 5 "� <br />Phone/E-mail y ��,ry�(O�t L? �iC� � • �-C'='� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �l! D(�O <br />Existing Use of Building 1�=7 � Uc�� ��= HEAT SOURCE: <br />Proposed Use of Building ��'�%`' �'� �� c� 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 p,ovided on the back) : C C� N V�'� Lr � l5 j]/li�� !r T/'� �'��= � j f�� �- <br />�Tti l�� �� Tl c-1�: �iZ— I= Z� r f'�'{�T� /tZ L/ v, ni ;����--t, �� <br />Have you started working without a permit? �YES _NO <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn �Alteration _Repair <br />Show Num6er (#J of fixtures <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 />Rangehood <br />Exhaust fan <br />, Heat pump <br />Unit heater <br />� Boiler <br />Refrigeration <br />Woodstove <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn J�,Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />�t Lavatorv (wash basinl <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <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 application and know the same to be true and correct. All provisions of laws and ordinances governing <br />this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the provision of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform the work for which ap ication is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />, � -�--��. � � � �Z' /�- <br />Ow er/ u orized Agent Signature Date (Revised 2/2011) <br />