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PERMIT° APPL.ICAiiOfV <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: � n c PROPERTY TAX # P�RMI��# �� �, j <br />. �' - � ✓� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER .{Y4, c Phone/E-mail ? �' r' <br />Address � �; � � City/State/Zip <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ Contractor�5 A9Eflf _ TBIlBflt (must provide a letter of consent from the owner to do work in lhe space) <br />CONTRACTOR ' �(_,�! �r State Lic. # City Bus. Lic. # <br />Address Phone/Email <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />, <br />�,.,,,1,��;�,� Sc..l,�..,�� <br />Phone/E-mail �� -� �lU -L�l� � <br />BUILDING PERMIT APPLICAiION CONTRACT PRICE OF WORK � �� G� <br />Existing Use of Building �;� �wn�l� `�i1t�� t'('�}'I,� HEAT SOURCE: <br />n r� /� I- �—�— <br />Proposed Use of Building �Sr���,�4-:�(/ �u'w�4� �C<ht,�Q,��_ Gas�L 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 QF WORK (additional space provided on the hack) : , r) <br />rl�,^_u.i �E�GIQ�c.'l C�✓i.fiL JV?ZJ �j - ��`Zfti'(Vl • !�?(�j Q��� � `y'i�' V���`,C�i �'�,�1 `^ t �' <br />G t <br />�� ' c�3 '�rs �-1 ( '� � <br />l�.�t-�-� c� z5� re �.�:tr� � � QJ,c' C�u,l �c r� 3(/r " IV� - 1� <br />!�/ l'.Lv (�(,QC� (,ryl K-� G�� c�.Yt��i � �rv� n JG�L� �. C'vY`K � K� c2.��'�y_ <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: �New _Addn _Alteration �Repair Type of Project: `. New _Addn _Alteration �Repair <br />Show Number (#) of fixtures Show Number (#) of fixtures <br />A/C - air handling units � Toilet <br />� � Forced air systems � � Bathtub <br />j Gas piping � Lavatory (wash basin) <br />� Water heater j Shower <br />Gas fireplace � Kitchen sink & disposal <br />� Gas range i Dishwasher <br />; Clothes dryer ; Clothes washer <br />Range hood � Water heater <br />� Exhaust fan � Sink (service/bar/mop/etc.) <br />� Heat pump I Backflow preventer <br />i Unit heater i Urinal <br />; Boiler � Drinking Fountain <br />; Refrigeration j Floor drain <br />Woodstove Grease trap <br />Ducting i Roof drains <br />� Other j Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM ; Other: <br />Number of Heads 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 fhis 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 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 />� <br />i <br />�.�-�.�� %�' � -� T -i <br />Ow�r%Authorized Agent Signatu Date (Revised 3/2013) <br />