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� <br />• <br />P'ERMIT APPLICATION <br />BUILDfNG/WIECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOL.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 />ADDRESS: PROPERTY TAX PE IT #„ <br />,�� �.���,����.�.,����'��;.�v�+���' R�.��a ����3a��'������� i3U�—�Z <br />AL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />�ER �ii°A%1?� 4� I`��s1ai��l0 � i?s"��3� Phone/E-mail ���' ��9j, �i`�'��'`s �'i��� P-ry/:+'7'�A�°'�.� <br />:ss : : � � � �a �T �is,�„�, �a�� �!� �. CitylState2ip �-�Er���rr �„w °i � � � � <br />APPLICANT: _ Owner � Owner's Agent _ Contractor _ ConVactors Agent _ Tenant �mus� Provioe a �euer or consem aom me awner �o do wonc m me sPace> <br />CONTRACTOR ��SE� � T. L& I Lic. #(�03 1 0390 COE Bus. Lic. # <br />Address 5(D�S �/Yf�'t (^lol.la�.l (tv. STic1l�Woop �0�92. Phone/Emai13(QO,�) ,L39 <br />TENANT BUSINESS NAME CONTACT FOR PERMlT ���6`� ����,�` �,� <br />Phone/E-mail �'j�`,����"�/1bp pfrE:.?'�i�R��ra%4e:�►�I?�P,r°q',L�F"� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK °�la, oo A <br />Existing Use of Building e� ��� t� � HEAT SOURCE: <br />Proposed Use of Buitding �� ���' � Gas_ Electric Other <br />Building type: `�'�' Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition � Remodel Repair T.1. Sign Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (addifional space piovided on me back): <br />��G'�r:':3i�•'�.7��ys�, R`.y�7���7�MP�, ����%��'�' � C��^1',9�ilt�� �+'�;���14��a11� 1' �s`�v►tiy�9iil o'f' 'lf�l�j�hiA�� y�[,�. <br />�a��r•1� o+� r�t�"� �+s�� '� Sh��� K���.°.���u�, �.�,,kl�`�,��r.ra�'�A�N <br />MECHANICAL PERMIT APPLICATION <br />Type of ProJect: _New _Addn _Atteration _Repair <br />Show Number (!� of fixtures <br />. AYC — air handlina units <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refigeration` . <br />Woodstove `� <br />Ducting <br />OY.her <br />ISUPPRESS <br />Number of Heads <br />PLUMBING PERMIT APPLICA'UION <br />of ProjecE: _New _Addn _Alteration _Repa�ir <br />Show Number (#) of fixfures _ <br />. Toilet <br />Shower <br />Kitchen sink 8 <br />Backflow <br />drain <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read antl examimed this appNcation and know the same ro be true an0 cortect AB provisbns of laws and ordinances goveming thfs type oT work w�l be complied <br />with whather specified herein or not The granting M a pertnit does rrot presume to give authority to violate or cancel the provision of any other state or local law regulating consWction <br />That I am authoraed by the owner o4 this property to perfortn the work for which application is made and 1 compy with the State Contraccors Law 18.27 RCW and 2a6.200A WAC. <br />Li�--�� _ ` /� ( ✓ <br />Owner/Authorized Agent Signature Date <br />(lievised 6/2012) <br />�/Z <br />