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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: f PRO� R� AX #� � P IT # <br />�.� 7F. /`!, , � � r.' IYa`_� O � <br />LEGAL for new construction: Short Plat/subdivision_________ ___ ____Lot No._____ (attach copy of long legal description) <br />:� �, ,a'i.•� �@ , " .�;. o y .i <br />OWNER �,..,� 3ry� ---' � i:t�,;,�"�, a t�..�,% Phone/E-mail <br />=- ; � �-� � <br />r , <br />� y -. _ ,; s--. ., .. <br />Address �-j3 � �� V' ;.: u `� '��`� `�P� -�_ City/State/Zip � ; �,s �.�.�b �,,, -�._ �, ,� .� :� • �`<�,. �j �.,. <br />_.-�-] <br />CONTRACTOR E_�-t �. ����� ;� �� � (�� � e'�� t'l �_�- � �''i ` ;� f L & I Lic. # /�_�,'' t; �- "�' � % � �:� `-�•�� <br />I b <br />Address ' � �-L(. (,,,� • '� <'--L� `'� tc._'� '� _ �. -. t `.�'_f ; t" _ � ,e:� �4 Phone/Email �- `� .��-.-�.w_� � �:_�:.- � ��. <br />TENANT BUSINESS NAME CONTACT FOR PERMIT =.� f _ -- f, <br />+� , �- ���'r-' `� �� „� �l'C� <br />; ,. <br />�` � �' � � �� _`.� � t �= �`-�' � � ��°` _ Phone/E-mail �. �,. _ - � �.�- <br />BUILD1NG PERMiT APPLICATION CONTRACT PRICE OF WOR}(�r��:��;� �______ <br />Existing Use of Building ___ _____ HEAT SOURCE: <br />Proposed Use of Building _________________ Gas____ Electric Other <br />Building type: ___ Single Family ___ Duplex ___Townhouse ___ Multi-Family ___ Commercial <br />Type of project: ___ New ___ Addition ___ Remodel ___ Repair ___ T.I. _;u� Sign ___Sprinkler ___Demolition___Change of Use <br />Description of Work (additional space provided on the back) : � <br />�,\a���� [ (f �� � �`' F ;I F'" f __. � � ,��'t.t . _- . �'�``t,.� �- ^1°'T_ �'�t �- <br />�_�' �� � �: <br />Have you started working without a permit? ____YES�a`___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 j Show Number (#) of fixtures <br />A/C - air handling units � Toilet <br />+ Forced air systems � Bathtub <br />� Gas piping Lavatory (wash basin) <br />Water heater Shower <br />i Gas fireplace ' Kitchen sink & disposal <br />! Gas range ; Dishwasher <br />Clothes dryer � i Clothes washer <br />i Range hood ; � Water heater <br />Exhaust fan ' Sink (service/bar/mop/etc.) <br />Heat pump ! j Backflow preventer <br />Unit heater ' � Urinal <br />i Boiler Drinking Fountain <br />y Refrigeration Floor drain <br />Woodstove Grease trap <br />Ducting Roof drains <br />� I. Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM i Other: <br />I Number of Heads ', 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,�rform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />.� ` �`�, � `i , - -_- _ � i, � Z� <br />`� O 'r/Authorized Agent Signature ^ � � Da1e � (Revised 2/2019) <br />