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SERMIT APPLICATIOIN <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: �/7 _�'A J� <} PROPERTY TAX# PERMIT# <br /> I I Z`-' (i"J'-f✓ i 1. ri��l'1 l"r D 1 00 ')0-� <br /> LEGAL fornewconstruction: Short Plat/subdivision f Lot No. (attach copy of long legal description) <br /> OWNER ," pl-E I Tv1 t w�S !/��- Phone/E-mail <br /> Address �01 5E ��, -M.,,1/� k,)i,l City/State/Zip Evertl�i' �g�d l <br /> APPLICANT: Owner Owner's Agent Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR t:��x cLvl f, �✓�(?-'n L&I Lic.# �U� �c-2 i-�S� (� COE Bus. Lic.# ( �1 <br /> Address �� S� r j [✓t W�r �� �v� Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> .-I-) Wt3f�f 1 tjlzfnS ZoG,-76> - (7`j`t <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 7� r 00<1 <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. Sign_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): r <br /> d t o�jh t- q� Y6 Vh tS t -rwo Ci� <br /> J- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn J Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> j U A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> s 1 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 Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> 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 this type of work will be complied <br /> with whether specified herein 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 owner 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 /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />