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ERMIT APPLICATIO <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 />TE ADDRESS: � r O� �� <br />!� <br />LEGAL for new construction: Short PlaUsubdivisi <br />OWNER �(�-��Q� �I(� � ( <br />Address ���� ����.r,� � <br />APPLICANT: _ Owner � Owner's Agent _ <br />CONTRACTOR � Y. D ��' ,�'j <br />Address l�i�(} �'}�j�(�,�/ � <br />ERTY TAX # <br />P N�IT #_ <br />��il�� —U� <br />No. (attach copy of long legal description) <br />Phone/E-mail <br />,�% �� 4� ICity/State/Zip IV� 1���7('jU �'j , N1 N• f�iif(.�-� � <br />, <br />Contractor _ Contractor�S A90flt _ T2f18fif (must provide a letter of consenl from lhe owner to do work in the space) <br />State Lic. # � � <br />' 7' ��� y,�q ( ,� �'jti� ��(,� � Phone/Em�il <br />� <br />Bus. Lic. # <br />TENANT BU5INESS NAME CONTACT FOR PERMIT p��,n1.. �1a2 ��{}� <br />���� l!V (� W R`�G PTio �e/E�ag'Z`g3g �z� �,�ber�-o @c�ho. <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF' WORK Ca <br />Existing Use of Building �� CO���•��- HEAT SOURCE: <br />Proposed Use of Building C�1�M�(�(/I F-�r--ra � 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 />MECHANICAL PERMIT APPLICATION <br />Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />� Forced air systems <br />Gas piping <br />i Water heater <br />j Gas fireplace <br />( i as range <br />� C hes dryer <br />( � Ran hood <br />_�, 1 Exhaus an <br />Heat pum? <br />Unit heater <br />Boiler <br />�j0► i Ducting <br />�. � Other <br />SPRINKLER / SUPPRESSI <br />� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Pt�ect: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />' Bathtub <br />I i Lavatorv (wash basinl <br />� <br />1 <br />Shower <br />Kitchen sink � <br />'shwasher <br />CI es washer <br />Wate heater <br />Sink (s ice/b2 <br />Backflow ever <br />Drinking Fou <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />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 herei: i 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 ow r 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. � <br />^ r � � <br />✓ � _ � ` <br />Owner/Authorized Agent 'gnatur Date (Revised 3/2013) <br />