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,� 1�r' ,� ,� <br />� � <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 />SI E ADDRESS' �.� PROPERTY TAX # PE IT # <br />�%'-e� �°''/1,�'�r�' /r'%� o� Iik. !`-�%;�f=T `/�t'�'r C'..�CJ �=� n 31 C� �e�F� O � �� � ,� i `� <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />�%��� . � /'�,= k°%f i ;�' �- � 9-? �� =�- �, <br />OWNER E ��/` � `�J/�i��� , d � i' /J Phone/E-mail l j • l ,j � _ <br />Address �! �) / ( y��� ��� r�"'` !�'r f �'����� City/State/Zip C` G���f^�%, l.%�%J <br />PUCANT: V Owner _ Owner�5 A9BI1t _ COf1fl8CfOf _ COIltr8CY0f�5 A90fll _ T@fl0fll (must provide a lelter of consent from the owner to do work in the space) <br />ONTRACTOR <br />dress <br />TENANT BUSINESS NAME <br />��,..,.•- � �/ <br />f i �t,c�G"� f-1� (( S <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />City Bus. Lic. # <br />IPhone/Email <br />CONTACT FOR PERMIT �;� f f�,��: �� <br />Phone/E-mail �'� S ,/J,��j ��i ��'/✓.�l.lw° ��r/.!�. D.�/-� <br />CONTRACT PRICE OF WORK _�, �- �� � <br />Existing Use of Building <br />Proposed Use of Building Gas <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _De <br />DESCRIPTION OF WOR�K (additional space provided on the back) : /� <br />�f�i�r''�/l' /`- ,f�f"'`��� ✓ ` ����-��`l %�/� C � �z���//s - ; <br />����✓�'sc �/'E /r''�%�'�' �'�`"`/'?r��r s <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />I A/C — air handling units <br />� Forced air systems <br />Gas piping <br />j Water heater <br />1 Gas fireplace <br />i Gas range <br />; Clothes dryer <br />� Range hood <br />� Exhaust fan <br />Heat pump <br />� Unit heater <br />, Boiler <br />j Refrigeration <br />j Woodstove <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />Electric Other <br />olition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />' Bathtub <br />i Lavatory (wash basin) <br />j Shower <br />� Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />i Water heater <br />I Sink (service/bar/mop/etc.) <br />� Backflow preventer <br />I Urinal <br />i Drinking Fountain <br />� Floor drain <br />� Grease trap <br />I Roof drains <br />Medical Gas <br />i Other: <br />� Other: <br />I hereby ce�tify 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 regulaiing construction <br />That I am authorized by ihe 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 />= �% �_.��� -/�= �z <br />� � � <br />Owner/Authori ed Agent Signature Date (Revised 3/2013) <br />