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� • <br />PERMIT APPLICATION <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: PROPERTY TAX # P MIT /� //� <br />•--,3 /' �'��(i'<��; �,� l : �. r:�� �// �� �S '� (� � �� �� L <''J G� � 1 �(.� � � �( " I <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER f`�C�f �/%6'l��J//��<? ��-%R��%Gj�d�T ` Phone/E-mai17C�? r�J_� c-� � � L L <br />Address J� !� � � L����Cj�l��— �1��/� �� Ciry/State/Zip �� ��e=���� ��f !� � <br />APPUCANT: Y Owner _ Owner's Agent _ Contractor _ Contractor�5 Ag2flf _ T21l2f1t (must provide a letter of consent from the owner to do work in the space) <br />ONTRACTOR <br />Address <br />TENANT BUSINESS NAME <br />C1A (� � `> !�► 5 <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />Bus. Lic. # <br />CONTACT FOR PERMIT��� �,✓�t f� <br />Phone/E-mail,;�'a: sou�'. G� �'U j`�>�/�a�E`l%1, t�i�l=� <br />CONTRACT PRICE OF WORK`t/ ��� �. !�'G5 <1 , <rZ? <br />Existing Use of Building HEAT SOURCE <br />Proposed Use of Building Gas Electric � <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler_Demolition Chang� <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />j'r ��/�' �G'GdT/���/ , 5 //�j�G �'E`"�'�/.�' /��C l�/ �'�c ;°�:,'/o✓ � F� iv?i��-''�"r= -' , <br />�'r?rv 6's � ��'�``� � Tf /��'�'/'�,�'�'"'/'% � �-� ; -;5-. <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C – air handling units <br />� Forced air systems <br />Gas piping <br />j Water heater <br />I Gas fireplace <br />Gas range <br />� Clothes dryer <br />� Range hood <br />� Exhaust fan <br />Heat pump <br />� Unit heater <br />� <br />; Boiler <br />� Woodstove <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />Other <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />! Toilet <br />; Bathtub <br />� Lavatory (wash basin) <br />j Shower <br />; Kitchen sink & disposal <br />Dishwasher <br />j Clothes washer <br />' Water heater <br />i <br />I Sink (service/bar/mop/etc.) <br />� Backflow preventer <br />� Urinal <br />i Drinking Fountain <br />! Floor drain <br />� Grease trap <br />I Roof drains <br />� Medical Gas <br />I <br />j Other: <br />� 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 pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�,, <br />Owner/AuthoJ�fz�,d"Agent Signature <br />- ��� -/`/ <br />Date <br />� C� <br />(Revised 3/2013) <br />