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� <br />� <br />C� <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ITE ADDRESS: /��' � �,- AJ i"f . PROPERTY TAX # PERMIT # <br />��J�%`� d...�.C=� ��1� ��1d--� �-4�4Z�C���-i�l r �'�O'7' C�C-'% <br />�L for new construction: Short PlaUsubdivisi <br />ER � d-��J � L �- <br />>S 1'?� i i c� N� i'�-"��`'' <br />'LICANT: _ Owner �' Owner's Agent <br />NTRACTOR V' ,/11 � �� <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail G.v� ""'�1 �� ' � T � � <br />j_ � 0 �� City/StatelZip �'J��[ypj�.{���L;� <br />Contractor _ Contractor�S Ag2flt _ T@f18�t (must provide a letter of consent from the owner to do work in the space) <br />L & I Lic. # <br />COE Bus. LiC. # <br />Address Phone/Email <br />TENANT BUSINESS NAME CONTACT FOR PERMIT •��Z-Z L,��:��'r <br />C�6��-`� L. L�- �L� - 2 Z u-�� �t �, c> <br />Phone/E-mail � �CU � � � � � r C <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK C� <br />Existing Use of Building� p/.iC"-� +.� �e4�4,ifl_.�{ ����D�N1C;re HEAT SOURCE: <br />Proposed Use of Buildingf�t Di.u►LT �p,,�.�•(.iL`�'' �L �t`1,� Gas Electric � Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition � Remodel Repair T.I. _ Sign _Sprinkler7� DemolitionJ� Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� t-i v�� 6� � g- L7 s� `z o P� �� �-r �.� r� t L..�t 1-t �►M �- l•�i �-r 1� <br />� � � t�� i�i.�-�L �.t�t i � � � r� <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 fixtures Show Number (#) of fixtures <br />A/C — air handling units � Toilet <br />Forced air systems -� � Bathtub <br />�. Gas pipinq � Lavatory (wash basin) <br />Water heater <br />Gas fireplace <br />Gas ranqe <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriaeration <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Shower <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Backflow preventE <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this applicalion 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 specifed 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 perform the work for which application is inade and I comply with the State Contraclors Law 18.27 RCW and 296.200A WAC. <br />�---- �.. <br />� � �--___�T � �"'�-� .� -- i t — � Q � � <br />OwnerlAuthorized Agent Signature Date (Revised 6/2012� <br />`�.�.,�z. L��.�Y �Z-� - 22v -- �c� �, d t � <br />