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• <br />�;1��' �i 3 <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 />S�E�DDRESS; , � � , /� �`T a IPROPERTYTA� � r, I PERM'IT-#��� - <br />/ c� ,� ✓'�,�;�� %C l� ./i�. ���f=J `/�� -✓ G Q E� D.� C� �c�[� b L c) tj (tj i�'f 01 <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER E �"�( (_ /% ���,_'/.J/fv'(7 ,�%��j jL�L���%% y Phone/E-mail %l,� � j � �t�� v <br />Address ��`>� ( y���� .rS �� ,�l�F� C j����� City/State/Zip f ���Fc`^i�/� 1.�� <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�5 A90ilt _ TBf12�f (musl provide a lefter of consenl from the owner to do work in (he space) <br />ONTRACTOR <br />s <br />State Lic. # <br />Phone(Email <br />Bus. Lic. # <br />TENANT BU51NE55 NAME CONTACT FOR PERMITr��� f�,�Er,r-�� <br />�- <br />� � ��. �� � � l � Phone/E-mail iL-J .i DCi`, �_7 �C� �<'./�fl����!!�i'r`%. (.���'? <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I _ � � � <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ 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) <br />�f�f���C /L f �J/�_.� /[ C��Jf" ,/", %l/'i'C'` ( . ��r ,�`�.�J,�i : <br />� � � <br />��`Ii✓l' �"C �/' c�-- %/�,�%,�'O -'�r'/?"�c=%�� <<- <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />� Forced air systems <br />i Gas piping <br />j Water heater <br />� Gas fireplace <br />� Gas range <br />� Clothes dryer <br />� Range hood <br />� Exhaust fan � <br />Heat pump <br />Unit heater <br />Boiler <br />� Refrigeration <br />� Woodstove <br />I Ducting <br />I Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />( Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />j Toilet <br />I Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Backflow pre <br />Urinal <br />Drinking Fou <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />nter <br />ain <br />I hereby cerfify 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 oevner of this property to pertorm the tvork for which application is made and I comply with the State Coniractors Law 18.27 RCW and 296.200A WAC. <br />,�'�:'�%� ;� � �_ c_ � L�� <br />. / � �� �� <br />OwnerlAutho�i �d Agent Signature Date (Revised 3/2013) <br />