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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 />a��REss: 7601 Evergreen Way, # E001 <br />LEGAL for new construction. Short Plat/subdivisi <br />R Reaencv Centers <br />ROPERTY TAX q <br />No <br />IT # <br />(attach copy of long legal description) <br />Phone/E-mail 503.603.4709 <br />�dress 5335 SW Meadows # 295 �aty�state�z�P Lake Oswego, OR, 97035 <br />PPLICANT: _ Owner � Owner's Agent _ Contractor _ Contr�ctor's Agent _ Tenant �m.�=r;,�o�.��ae a�,ene� or�onsem r�o�, u,e o,�-ne� io �70 �.vo�x �, ir,e si�ace; <br />'' � � II�]�J <br />Dollar Tree <br />State Lic. # City Bus. Lic. # ' <br />Phone/Email �� �"�/U (l � l/� � � � «/�' <br />CONTACT FOR PERMIT <br />Andy Paroline/ andy@parolineassociates.com <br />Phone;E-mail �nF �� a n��a <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ���U <br />Existing Use of Building Grocery HEAT SOURCE <br />Proposed Use of Building Retaili Grocery Gas� Electric_ Other_ <br />Building type. _ Single Family _ Duplex _Townhouse _ Multi-Family X Commercial <br />Type of project: New Addition Remodel X Repair _ T.L Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the backl . <br />Interior remodel for a new Dollar Tree: � I�Z�iit� .�2 �� �-� �7��T Z'-t��zh- <br />. Z � / �v" � v� � <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New_Addn �Alteration _Repair <br />Show Number (#J of fixtures <br />A/C – air handling units <br />Forced air systems <br />� Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />�— Ducting <br />Other <br />SPRINKLER ! SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn �Alteration _Repair <br />Show Nurrrber (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dis�os <br />hwasher <br />Clot s washer <br />Water ater <br />Sink ser e/bar/mo <br />Backflow pre nter <br />Urinal <br />Drinkin Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certlfy that I have read and examined this application and know the same to be true and correot All provisions of laws and ordinances governing thtis type of work will be ;-omp <br />with whether specifled herein or not The granting of a{�enrit does nnt presu�ne te aive authority to violate or cancel the n�ovision of any ottierstate or looal law regulating constr'ucGon <br />That I am authonzed oy the c�wnei f his pr p. rty to pc: rfonn the wnrk for which �pplic�tion is made and � comply with the Stat�, Cnntractors L�w 18 27 RCW and 296 200A WAC <br />� L� - 2 �• ��5 <br />Owner/Authorized Agent Signa re Date (Revised 9/20141 <br />