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�ERMIT APPLICATIO � <br />� ir3UILDING/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� ADDRESS:'�,( , . � �jv`��� �� PROPERTYTAX# P�11p�Lf _� , <br />t� � <br />''-�' .> <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER �-1� " j�-� r ,{,� Phone/E-mail �-� 2 � ` � � Z ' � �-I� <br />Address �i' 4� `'t � 3.�.v�� �,� �g"� City/State/Zip ' �i�� �{ �,�,j � ` i L5 .�' �- '� <br />APPLICANT: _ Owner _ Owner'S Ageflt Contractor _ Contractor�S A90flt _ T0f18f1t (must provide a letter oT consent from the owner to do work in the space) <br />CONTRACTOR � �� i� (�� ,1'�J� �::, State Lic. # �;�-t.y F � Fi-t $+� � � ( � City Bus. Lic. # �7�: L� �1 �✓ <br />"1 � ��� ? u S� S"►'ti �- I <br />Address �i;, • � v� ' -,� � v ��y �, �; ` �j Phone/Email ``i Z� - � 1 � ' � 1 j u� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />�/ L°.,�� � l..:v.�. �'� r.;.. �, ? <br />Phone/E-mail � •���� �,l l.c (� � Gi ' L �YL^�`� i � . C � � �^� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � l� �, �� �� <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 />T e of ro�ect: New Addition Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />i)�'9 � � �r�S ��_i6�,;� �,'���� ��s Ez�l.t <br />� L << F 1-{ V) ► 1 `. �.1 � I �' � I � �'� �4 ✓ --t_ <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 handlin units Toilet <br />' Forced air s stems Bathtub <br />� Gas i in Lavatory (wash basin) <br />Water heater Shower <br />Gas fire lace Kitchen sink & dis osal <br />Gas ran e Dishwasher <br />' Clothes dr er Clothes washer <br />Ran e hood = Water heater <br />Exhaust fan Sink service/bar/mo /etc. <br />Heat um f Backflow reventer inside bld <br />Unit heater � Urinal <br />Boiler Drinking Fountain <br />Refri eration ! Floor drain <br />[ Woodstove Grease tra <br />; Ductin Roof drains <br />Other Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads 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 comp <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 />Th� I am�uthorized 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 />, �,}' 1'/� � <br />/ 1 _. // II�„ <br />r\_- � � �� � I � t-'� I � � Q� 1 <br />Owner/Authorize Agent Signature ' Date "� ` V(Revised 4/2015) <br />�../ <br />