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• � <br />� <br />PERMIT APPLICATION <br />BUILDING/NIECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />www.everettwa.org <br />SITE ADDRESS: PROPERTY TAX # �RM T� J� <br />3 �' ' � > ( �� - - >�> - c - <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER �,,;� " (_h`�. Phone/E-mail - - � ��— " 'G'' " <br />Address -� \. } L' "�;, • / City/State/Zip ""-' ��" �' , ,;"' <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�S AJOfIt _ TEf18f1t (mustprovide a letter ofconsentfrom the ownerto do work in the space) <br />CONTRACTOR �" y L& I Lic. 1� ` COE Bus. Lic. # <br />Address ��� j c- r�(� L[ �"-� �.` � L' C� Phone/Email ��� � -- �` <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />�`? ` �"�-% _ - .7 <br />Phone/E-mail Z'� - ,� " - <br />BUILDING PERMIT /�PPLICATION CONTRACT PRICE OF WORK �U -(.,1 ; <br />Existing Use of Building �`,1.-ty:-rt.�r''=: i� 5/j�Gc�. /�/.�-/l� HEAT SOURCE: <br />Proposed Use of Byilding_ ��-5 i c�,,� „� i• �,_� SIC�/ Gasj� Electric_ Other <br />Building type: i�Single Family _ Duplex Townhouse _ Multi-Family _ Commercial <br />Type of project New Addition ir/ Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� <br />. � � �� � i� _,.�T�' � �-:: F�_ �.�.� ,-� � <br />`�� ��_ i-�`'�.-= d:. ���� � 1 .%` �� �' ,c�; �c� �e j \ ,:.t-�. � <br />MECHANICAL PERMIT APPLICATI PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Adiin =Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show Number (#) of fixtures <br />A/C - air handling units Toilet <br />Forced air systems Bathtub <br />Gas piping � Lavatory (wash basin) <br />WatE:r heater Shower <br />� Gas fireplace Kitchen sink & disposal <br />Gas range Dishwasher <br />ClotYies dryer Clothes washer <br />Ranqe hood Water heater <br />Exhaust fan Sink (service/bar/mop/etc.) <br />Heat pump Backflow preventer <br />Unit lieater Urinal <br />Boiler Drinking Fountain <br />Refriyeration Floor drain <br />Woodstove Grease trap <br />Ducting Roof drains <br />Other Medical Gas <br />SPRINKLER / SUiPPRESSION SYSTEM Other: <br />Number of Heads Other: <br />I hereby cert'rfy that I have read and exarnined lhis application and know the same to be true and correct. All provisions of laws and ordinances governing lhis type of work will be complied <br />with whelher specified herein or nol. The� granting of a permit does not presume to give authority to violate or cancel the provision oi 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 wilh the Slate Contractors Law 1827 RCW and 296.200A WAC. <br />i �� <br />' ' �' %� ' ` �z-�r - � <br />-�%��'r � r, z� 2� l r'l'��;,�:: i� <br />OwnerlAuthorized Agent Signa`T�i Date <br />(Revised 6/2012) I <br />/ .� <br />