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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 />SITE ADDRESS: �� <br />I UL!� d'� �-tU �-T <br />LEGAL for new construction: Short Plat/subdivisio <br />OWNER �(7 � � / r, � : ( ��. L� t �T <br />ress ��: f �-�i �'' �'�i �.i.t� l LZ <br />�LICANT: _ Owner _ Owner's Agent <br />..�. , A <br />ONTRACTOR (,r�t1L��Z� <br />9dress �- � � �% ���}-��-�( C� <br />ENANT BUSINESS NAME <br />PERTY TAX # <br /># <br />%�'� <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail - �,�� °] Z(,' - l-t'l 5 <br />'� 7` U _ City/State/Zip � �� — �� <br />Contractor _ Contractor�S A9@flt _ T0fl8flf (must provide a letter of conseN from the owner lo do work in lhe space) <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Em <br />�L l.� ,J"t �i; <br />hone/E-mail ��I ZS� ��Z-.` <br />ONTRACT PRICE OF WORK <br />Bus. Lic. # <br />� - �% / �F- /��.�� &- e 5 SG <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 projecfi New Addition Remodel Repair �T.I. Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />�-u���s� � ��-���v��,�-- �� Zu� 1���°���s� ltL�� �� `��--�,� Ys��� <br />fVIECb�►NICAL PERM14 APPLIC�4�lON <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />� A/C - air handling units <br />� Forced air systems <br />i 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 />! Ductinq <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />PLd,lM�IldG PERMI� APPLICATIOtd <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />; Toilet <br />I Bathtub <br />Lavatory (wash basii <br />Shower <br />Kitchen sink & dispo <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mo <br />Backflow preventer <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 ihis 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 properly to pertorm 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 />�� C�� � - l 'l � � <br />OwnerlAuthorized Agent Signature Date (Revised 3/2013) <br />