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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SP'f�INKLE�/DEMO�ITION <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: ,_, � , � � , r ' PROPERTY TAX ti PERMIT # <br />. r ! , � �, — � ; -� v � i L! C. �) 1 _ � _ <br />l <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER "�,4 �� . ��� , "� � PhonelE-mail -- -'' `7 - l � �7 <br />n �- ( r , <br />Address , � 5 . 1 � '` ` i �I I � d �'�-�J � City/StatelZip �: � , f �'1 � '`. i : �. . "! . <br />�J� <br />APPLICANT: _ Owner _ Owner's Agent k Contractor _ Contractor'S A9eflt _ TBf1Bf1( (must provide a letter otconsent from the owner to do work in the space) <br />( �-� _ � <br />CONTRACTOR -) � i� , � c:�,n . 7.�'v �!� ��'h i'IC L& I LiC. #�'� D'� `"_ i,�`_-� S�, J COE Bus. LiC. # <br />Address �, v �� " .���; �� Gl ! Lj �-_ ; �, C� �' �l.' ,i Phone/Email � 1 ��j - ~i C.i - �'�j � <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />t--�. �t�v1 1_ i �� C� �'`) <br />Phone/E-mail ! 1,'? � - j � C _ � �� � <br />BUILDING PER��IIT APPLICATION CONTRACT PRICE OF WORK ','� ��'�': c'�-' <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Buiiding �/�/� Gas Electric Other <br />Building type: .`'� Single Family _ Duplex YTownhuuse _ 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) : I ,. , �^ <br />. . . =?4 0� �,., . i' ,:� -? � � (� `, 'n �' �1"C h v 1 "' �1 y' C' (�"" i ''! y°. . \ ,. :/ i" C. v 'C 9' � ..+, \ � ' ;� � � 1 c.i�.il �" :. �. G �- � (�� ✓' � <br />.��. '� - . .� ` ', ' <br />`' ^ <br />�--, ��.. � U 'i �/i `i V "- '::l �7 `�A�^ i ! 1 % � ` i O.il�Y1 � Gl �- i C� � <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 fi�rtures Show Number (#J of fixtures <br />A/C - air handling units Toi!et <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 />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 ceRrfy that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this type of work will be complied <br />with whether specifed herein or noL The granting of a permit does nCt presume to give authority to violate or cancel the provision of any olher state or local law regulating conslruction <br />That I am authorized by the owner of this pr�erty to pe.�orm the work forwhich applicalion is made and I comply wAh the State Contractors Law 18.27 RCW and 296.200A WAC. <br />;i ;� �� � <br />� J <br />/� , ���;��: � � <br />� � , �� i ,.����j�i'- � ,�` _ ,� � / � 7- � C.� ` � � <br />. `t[/�i <br />Ov,mer/Authorized Agent Sigiiat ru e / Date <br />(Revised 6/2012) <br />