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� <br />• <br />. PERMIT �P�LIC�4TION <br />BUILDING/MECHANICA! /PLUMBING/SIGN/SPRINKLER/DEMOLiTION <br />CITY OF EVERETT PERMIT SERVlCES , <br />3200 Cedar St., Everett, WA 9�201 425-257-8810 FAX 425-257-8857 www.everettwa.orc� <br />��,1`. r� APPLI�r4TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRES : �) ��4'�.".'r%T L} PROPERTYTAX# P RMIT/#-Z ,�_ � -, � <br />'�%' f i� r=' � n, v s-1�/ I'_ N i! Y'' _ Lt �i�J � i�/ � f• ��/ <br />L for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER /�> -r, �;� <br />APPLICANT: Owner <br />CONTRACTOR <br />�� t c' L- L Phone/E-mail <br />CitylState/Zip <br />Owner's Agent y� Contractor _ Contractor's Agent _ <br />7"i ✓. <br />L&ILic.# <br />T211211t (musl provide a letter of consenl from the owner to do work in the space) <br />-', % : � rv�S �'akY �i'2 i�)f' COE Bus. Lic. # �r�;'% �-ic: <br />Address =�'C) �? / SG' j�' � iv/ J CY� "�� �' '� Phone/Email Z� . 3�' — C� 3 S/ <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />Phone/E-mail �'j � —� �� ,� � �� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK .-.,�„� ,: C. <br />Existing Use of Building S� 1 yi < i r ��-v� i�,/ ['v�L_ HEAT SOURCE: <br />Proposed Use of Building -� i<;+� ��' �'ar�•/�/ /�r�"�� - 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 />�/J �V�N�' ec�S y <br />/r� ��' � � S L���'��� <br />� � ' �i � `� %� ✓ A-G'7^-'� !` �, ,� / <br />C N --� <br />� �, , <br />� �:� � � � � �_��.,� � ; � -� � r <br />� C�''�7 G'� a - � � V G' �9 r ��j � ;.'1.. � �/_ VC O t� ✓r"7 J\ G" C"� ��''f --� T v'M ` r'Y rl -. <br />MECHANICAL PERMIT APPLICATION PLUMBING PER IT 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 ! <br />Gas piping <br />Water heater � <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Boiler <br />R.7'i1 <br />� Ducting <br />j Other <br />NKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dispo� <br />Dis;�washer <br />C�othes washer <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other. <br />I herety certify lhat I have read and examined this application and know the same to be true and correct. All provisions oi',�,:s and ordinanc�s goveming this type of work wiil be complied <br />with whether specified herein or not. The granting uf a permit does not presume to give authority to violale or cancel the provision of any other state or local law regulaling construction <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />_ - __ � <br />�_ � <br />�- .: �Wr,^ � _ <br />� _ � - _ - . ._,_ �`/S�Z-. <br />�- <br />0 vnerlA R�ent•3tgnature Date (Revised 6/2012) <br />T' <br />' <br />