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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 />SITE ADDRESS: PROPERTY TAX il PERMIT # <br />� 4 i3 � �, C L, � �'_�c.i7 -G'L`� <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER �'� � Li`YJ Phone/E-mail <br />Address l j/ 7 ' �vj� C�6 City/State/Zip ^ ��t� � � � `l �j <br />APPLICANT: _ Owner _ Owner's Agent �ontractor _ Contractor�S A9ef1t _ TBf18f1t (must provide a Ietter of consent from the owner to do work in the space) <br />CONTRACTOR �G C/`e i� ',�yL �' �; 7•; L& I Lic. #—' - COE Bus. Lic. # <br />n <br />Address �j I 9' (,�;JCi� �' � Phone/Email��W � % ' S' <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />Phone/E-mai I <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />9 <br />Existing Use of Buiiding f7✓L'�Y� Jf �. HEAT SOURCE: <br />Proposed Use of Building 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 />�'� Y U � � <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 />Gas piping Lavatory (wash basin) <br />Water heater Shower <br />� Gas fireplace Kitchen sink & disposal <br />Gas range Dishwasher <br />Clothes dryer Clothes washer <br />Range hood Water heater <br />Exhaust fan Sink (service/bar/mop/etc.) <br />Heat pump Backflow preventer <br />Unit heater Urinal <br />Boiler Drinking Fountain <br />Refrigeration Floor drain <br />Woodstove Grease trap <br />Ducting Roof drains <br />Other 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 lhe same to be true and correct. All provisions of laws and ordinances goveming lhis rype of work will be complied <br />with whether specified herein or not. The granting of a permit does nol 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 th�owner of this property to perform the work forwhich applicalion is made and I comply wilh the Stale Contractors Law 18.27 RCW and 296,200A WAC. <br />� <br />'.,��_�---�---��"'_:.- _..-7 <br />c_ / __.�:-� ���Z��Z� �� <br />Owner/Author�zed Agent Signature Date (Revised 6/2012J <br />