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• • <br />PERMIT APPLICATION <br />BUILDIt�G/MECHAMCAL/pLUMBING/SIGNiSPRINKLER/DEMOLITION <br />CITY �F EVERETT PERMIT SERVICES <br />32Q0 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.g�g � <br />�G <br />SITE ADDRESS: P P�R X q � IT # -n <br />� � :� �� ^ ,�� � �A /� �-�� �` '— � � , � ���`'� `��"�= I �2� <br />LEGAL for ne4+r construction: Short Plausubdivision Lot No. (attach copy of long legai description) <br />'7 ' ,r" - , ,-J <br />OWNER r(; - - Phone/E-mail Z.�j �,;.> —,�,� j�t� <br />Address ���`i LC�.- �f1L � }� � l�_• City/State/Zip �� �Ll l�',,.��- <br />i <br />APPUCANT: _ Owner _ O+vner's Agent �. Contractor _ Contractor's Agent _ Tenant �m�sl provido a Icner of wncent from the owner lu co v+ork in th3 tpaca) <br />CONTRACTOR �_.- - ( 41/ i � " J - � !L- • State Lic. #. 'Lt_C. . ( � �1 l',i'C /City Bus. Lic. # f L �-��� i � � <br />Address ' ��],��� '�'' � ^ I �%� Phonel�maiF'1L-�' "(`t � 3 i �c.4'}-`-���`il��j (�� tl' }�rTr <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <Z� f <br />' ^ �,•� � <br />" �,� S�{a� ��;�--�'� {� I <br />Phone/E-maif Z,G' '" .� � _ (,"S� °1 ��L'(MirL4�t�� Gi (C) �l���lt • ��. <br />BUILDING PERMIT APPLICATION CONTRAGT PRICE QF WORK -'' <br />Existing Use of Buiiding HEAT SOURCE: <br />Proposed Use of Building Gas 'Eiectric____ o�her_ <br />Building type: _ Singia Family � Duplex _Tawnnouse _ Multi-Family _ Commercial <br />Type of project: New _ Addition _ Remodel _ Repair _ T.I. �_ Sign _____Sprinkler TDemolition_Change of Use <br />DESCRIPTIOhi OF WORK (a rnona� sq ce provided on thebackJ: <br />L�?l� . '`�\� �77 ~'I��-�`' j��1 ���-__, <br />�l � <br />�� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: ____New _Addn _Alteration _Repair Typo of Project: _New _Addn _Altaration _Ropair <br />&how Number (#) of fixfures Show Number (�) of fixfures <br />� A/C - air handiing units { Toilet <br />� Forced air systems � Bathtub <br />Gas piping I Lavatory (wash basin) <br />i V��ater heater j Shower <br />' Gas fireplace i Kitchen sink & disposal <br />Gas range i Dishwasher <br />; Ciothes dryer � Clothes washer <br />i Range hood ; Water heater <br />a Exhaust fan � Sink (servicelbar/mop/etc.) <br />j Heat pump t3ackflow preventer <br />j Unit heater i Urinaf <br />; Boiler � Drinking Fountain <br />; Refrigeration j Flqor drain <br />I Woodstove Grease trap � <br />Ducting ; Roof drains <br />� Othar � Medicai Gas <br />SPRINKLER 1 SUPPRESSION SYSTEM j Other: <br />,%� Number of Heads � Other. <br />// i <br />I hereby cerlify that I have read and examined this applica�ion and kncw Ihe samo lo be truo and correct. All provisions of lpws and ordinances goveming ihis lype of v;ork wili be comp!ied <br />wRh whether specitied herein or not. Th r2ntinc� of a permii does not presiima to give authnriry to violale or cancel ihe provision of any other state or local la,v regulating construction <br />r <br />That I am authcrized by the ovrner ot ihis prop y to per�orm tha ork for which application is mada and I compiy with the S1ate Contractors law 18.27 RCN/ and 296.200A WAC. /` � <br />(� ,�� �, � �� �/��/ � j-- ,l{ � � � c,� _/ <br />� ( � � i c�L'� <br />; ' l ��.. � / <br />t ! <br />Owner/A thorized Aaent iqnature/ /,r� __-- Date (Revised 3/Z013) <br />