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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 />SITE <br />LEGAL for new construction: Short PlaUsubdivision <br />OWNER ` <br />PROPERTY TAX # I PERMIT � <br />�� l��'� '��} <br />Lot No. (attach copy of long legal description) <br />PhonelE-mail <br />City/State/Zip <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �m�5� P�o��ae a iene� or consenc r�om me ow�e� �o do wo�k �� cne SPa�e> <br />CONTRACTOR �,,'{��� <br />Address ��� ��._� �Zli � '� �► i 1 LY-P� <br />TENANT BUSINESS NAME <br />� � � �'�� ,`� `',,..� 4 � � �''J� � �^ �� � <br />BUILDING PERMIT APPLICATION <br />State Lic. # � ����%� ��ity Bus. Lic. # � ���� <br />,� �S� one/Email 'L��� ��j �l � �f � <br />CONTACT FOR PERMIT � /� <br />��n e/ . /� A��. .. ��-� �� ��1�, y'�r� <br />-��-��� -��_.� '�`�� � <br />Phone/E-mad � 1, ��-, '� p 1 � � �' � Z� �� � � �� �,ti <br />CONTRACT PRICE OF WORK %r��,' C� • <br />Existing Use of Building �-�P`'R`�5il„'� , HEAT SOURCE: <br />Proposed Use of Building Gas Electric Oth� <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� v� S�. i; 0� Y1�u% '��1�Pz �^ -��`� �� z Y'� �� v� ��� S�,��'�; �r� � <br />, ' <br />C�4� ��= S� �' � �'�l �--�2'� ✓�C� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />A/C - air handlin units <br />Forced air s stems <br />Gas i in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes d er <br />Ran e hood <br />Exhaust fan <br />Heat um <br />Unit heater <br />Boiler <br />Woodstove <br />Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer (inside b <br />Urinal <br />Drinking Fountain <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 goveming this type of work will be comp <br />with whether specified herein or nol. The granting of a pertnit does not presume to give authority to violate or cancel the provision of any other stale or local law regulating construction <br />That I authorized by the owner oLt�s pro eRy to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />�' � <br />� � ��/�i?_� 7'�- iS <br />� , <br />Ow er/Authorized Agent Signature Date (Revised 4/2015) <br />\�� <br />