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• <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: j�' � U� PROPERTY TAX il PERMIT # <br />y f7�� (�' C4Sf^'�D ��' t'v'�Yf�f �'�a F?IZ�d-(X.� <br />LEGAL for new construction: Short Plat/subdivision <br />�i� (� /'�7d �' <br />_Lot No. (attach copy of long legal description) <br />Phone/E-mail <br />Address � � p � [� 3 �,� • ;�- ' � �: r� f' W i ; [.q �i� City/StatelZip <br />APPLICANT:_Owner _Owner'sAgent _Contractor _Contractor'sAgent % T@fl8flt(mustprovidealetterotconsent6omlheownertodoworkinthespace) <br />CONTRACTOR -� �t � � - �'i2.ti.� N � F 'L L & I Lic. # COE Bus. Lic. # <br />Address ��L �- E' L/�SC�"� l�--� 4�i, i�'< f'f w� �l� J��' Phone/EmailC�jG� 1�('�`�r} 3p Li�-� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT ����, ��. ����,� �? � p� � Z <br />� �'--� l.:/%�l �,' l {- �� r� � .� Phone/E-mail � 4 �, �' . �J� __ 3 . <br />/ <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � 5��'C" == <br />Existing Use of Building ��' x�l� '� �! r�� y'� <br />Proposed Use of Building ��Jxt I� 7 6( c;���;;a <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family <br />Type of project: New Addition Remodel Repair _ T.I. <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />D���c� ����)( bfiNr� ���f�s, <br />a�d �-� �-� <br />MECHANICAL PE RMIT APPLICATION <br />HEAT SOURCE: <br />Commercial <br />Sprinkler <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Pro�ect: _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 <br />Gas piping <br />Gas fireplace <br />Gas ranae <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />rcerrigeration <br />Woodstove <br />� Other t:��-1-�f,�- <br />SPRINKLER / SUPPRESSION <br />Number of Heads <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Drinking Fo� <br />Fioor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />� <br />I hereby certify that I have read and examined this applicalion and know the same to be Irue and coRect. All provisions of laws and ordinances goveming this type of work will be complied <br />wilh whether specified herein or not. The granting of a pertnit does not presume to give aulhority to violate or cancel the provision of any other state or local law regulating construclion <br />That I am authorized by the owner of this property to pertorm the work for which applicalion is made and I comply wBh the Slate Contraclors Law 18.27 RCW and 296.200A WAC. <br />n <br />� ��-�.�./�.� - �1 a�,�.�.��.� lcs� <br />OwnerlAut orized Agent Signature Date <br />(Revised 6/2012) <br />