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n <br />LJ <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 />SITE ADDRESS: :,�;*C'� ') _ PROPERTY TAX # P MIT <br />�.� I � Z. � ��' o � � � ��.i G ... c� ,� ' � 7 ) l '� � r� �;' �` � ' � � - <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of �ong legal description) <br />. c c L���`"�-(�•'%)� ��� 4�=. <br />OWNER y � � I . C �' ; ` (,Q, C: .;/ L Phone/E-mail �� J �� �:_� - �� • C <br />. <br />,address -,,.5 ', z1Lt.iz-C�� �,�.!_�, Gi-� c�tyis�a�eiz�p `(".c.1�72.C���( . (, I ' �Jc�':�D <br />APPLICANT: �� Owner _ Owner's Agent _ Contractor _ Contractor�S A92fli _ T811af11 (must provide a letter of consent from the ownerto do work in the space) <br />CONTRACTOR 1 1 ` �+; r "ce v� ,-r State Lic. # �UH�yI 't" �'C ���� � �"City Bus. Lic. # <br />`- Z �- �3 �L r1 - �t �� � r�uj�. (+-i <br />Address `��'Z,s] 11`a�� �,, � � �%,' L hC �� .. �1�C-��� ' Phone/Email �f L �"` �S � ". �j�r ",. �'_: <br />TENANT BUSINESS NAME C�"1C.�'C��t�°/l ��'�ci,� �(,f,�(-c.E-�l CONTACT FOR PERMIT ��� ����� ���� ���� C:L'/7 <br />i.�.�� -- � �;�—S /�4� <br />Phone/E-mail �cZc��� � /y��d! F'� .r t.1�iL�s" (. ; CE'iL/ <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK b�-� S3"��y ��, �> <br />Existing Use of Building t 1 �i. d�� L�. v�j C� �. HEAT SOURCE: <br />Proposed Use of Buiiding C 1� �� i�' �l_+� �� :� `; Y-� Gas Electric � other� "� <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family �' Commercial <br />Type of project: New Addition� ``J Remodel,�'Repair _ T.L _ Sign _Sprirkle� _C�rnolitic� Ci�ange of Us <br />DESCRIPTION OF WORK fadditional space provided on the ba'ck) : ��% �� i i O✓ <br />,���J'�"� �- ���� � �%� �i '�-�C� - -/_f-�� /,:�..-!� � <br />,�- �� ��<�y�� x �C% �i <br />' �i � v� � 1��.� l�k%�-� �L �G�%�/ � <br />������ � � ����� <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 fixfures Show Number (#) of fixtures <br />A/C — air handling units � Toilet <br />Forced air systems ; Bathtub <br />' Gas piping i Lavatory (wash basin) <br />Water heater ; Shower <br />Gas fireplace ; Kitchen sink & disposal <br />I Gas range Dishwasher <br />Clothes dryer Clothes washer <br />Range hood Water heater <br />� Exhaust fan Sink (service/bar/mop/etc.) <br />j Heat pump � Backflow preventer <br />i Unit heater Urinal <br />Boiler i Drinking Fountain <br />; Refrigeration j 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 the same to be true and correct. All provisions of laws and ordinances governing this 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 18.27 RCW and 296.200A WAC. Y I <br />� � <br />i `.�L_,'1 Ci ,� �-,��_� I ����1�-( <br />Oyvner/Authorized Agent Sig ture Date <br />(Revised 3/2013) <br />