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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C dar 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 # PE IT <br />�,�la c-��Si C,�S��;o ��� �oy��l�oa�.-D3�--p� j ,���� �, ;� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER � jj�0 ��(� Phone/E-mail �y�-S y0% "%�C�(5 <br />Address �,�.(� / L 7 Q���SQ�,i City/State/Zip r��/�j' �� L,j/.} L'��Q,� <br />CONTRACTOR .5M I TN �In'h �' S�'�'�.S L& I Lic. # 5M 1'Tl{ (j i 3(pC�'T <br />Address //(�(i; �t-J�; ,1��/� ��jJj T/aC.l7ai�i l�i�-i Phone/Email �J�,�1ig—�0�� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />r AA�� N��S�N / <br />��C) I' ���i Phone/E-mail �'3��.�1 —�t 1 c�I1��SO;I�k'-�J�z1�"fltT�;L*'.C�'% <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK J � I C13 <br />Existing Use of Building W�vu�E `-��C.� HEAT SOURCE: <br />Proposed Use of Building �F�< <L .`S�%(.� 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 />�i�TC-/L%�li��l `i��.J��rl..'� JJir'�iV�� �S i �51 ��1 � ( �.l <br />i�ELor.i NfilJ f'L�%Z�NIti�. <br />Have you started working without a permit? _YES �,NO <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 />i A/C — air handling units Toilet <br />I Forced air svstems I Bathtub <br />Water heater <br />Gas fireplace <br />Gas ranqe <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />� Ftetngerauon <br />W oodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <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 />Urinal <br />Floor drain <br />Grease tra <br />Medical Gas <br />Other: <br />� c� � I Number of Heads � � I 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 <br />this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the provision of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform th work for w c application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />��- ',��� � =a,3 - � 3 <br />OwnerlAuthorized Agent Signature Date (Revised 2/2011) <br />