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1 , • • <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.eyerettwa.org _ <br />SITE ADDRESS: p ' PROPERTY TAX # PFRMIT # <br />�l �� S,t. l`��'�'�� ��l�.�l �.� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER Phone/E-mail <br />Address City/StatelZip <br />APPUCANT: _ Owner _ Owner's Agent � COf1tf8ClOf _ COIlif8Ci0f�S A9Bf1t _ TBfl2flf (musl provide a lel�er of consenl from lhe owner to do work in lhe space) <br />CONTRACTOR jv„;1�� �•F� , �� State Lic. # ' Iv �CSS���l��ity Bus. Lic. # <br />Address 2(,^.�.-�% "�I�J, _�,: L' 1`,a. .��- 5 L+�.�� � �.l,�i ' i.l> � Phone/Email Zi:Z _. �y. � �L� � t<<'.-„' Gylir,`� C 4'N) <br />TENANT BUSINESS N ME CONTACT FOR P RMIT ��C ,. � ��`� -t+'}'t��' <br />, �I l � , 1:.�-1�:- �.:�.,i'�'; `,� <br />'- %`'' ' '� : li �.1; � lL` 1,,, V; r � ' i , � `7 �-a,V1 � t-� � '� <br />'' V1 ` Phone/E-mail :>�'� � C=, c} i <br />BUILDING PERMIT APPLICATI N CONTRACT PRICE OF WORK _ 2�Q, .� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Buiiding 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 (additionalspace\providedontheback): j,���,}-C;�� L,�, �j� �,�1 `�� j y���tr—� �'�=��'�-� '�'1�- <br />er„� �` ���� '��.�;-"�'_S� ► c:��� ;�S�V„� %r� C.� �f`� —�;��-c� I.�t::t�� .� <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 />i 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 Medicai Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />• - Number of Heads � I Other: <br />I hereby certify that I have read and examined ihis 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 speci(ied herein or not. The granling 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 lhis property to perform lhe work for which application is made and I comply wilh the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� � yL <br />1, � f� , `-�- � �� S �� <br />ti <br />Owner/A horized Agent Signature Date (Revised 3/2013) <br />