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i <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />I r RESS: p PROPERTYTAX# P,�j MI ^ <br />� C }� �%(7 � . t ,/�-i�v !% .�n� II� � ��� ��iJ � <br />LEGAL for new construction: Short PlaUsubdivision <br />V 13TL c Ow �u� S /-4-SS � c' �'y� o� <br />OWNER t/,� N,tn. 5>I,.� c�� '� (�,�.,.,-.._...h. Ma. <br />No. (attach copy of long legal description) <br />Phone/E-mail 'i%L5. �`►7.59�c, <br />Address � SSa 3 � �l E 8�' S� �,5�; �� 2ou ICity/State/Zip '��(W� �� , �%$ pp8 <br />APPLICANT: _ Owner �OWn2f�S Ag211t _ COfltfBCtof _ COnff8CY0f�S AgOfll _ TBnant (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR �C l G �d �,� �t,�c.�f'I u„� �� L E� I Lic. # � �OCLQS j � COE Bus. Lic. # <br />Address �( ��j � � yD�' S�', 4 1Aie}. . Phone/Email 2l�, 6�5, �$,37 <br />TENANT BUSINESS NAME CONTACT FOR PERMIT ��rn ([ � J�(-0NS� �},},�}S. <br />Phone/E-mail �2`'�� 2�}$. �7�i2 <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK�, 2�J �• i8 <br />Existing Use of Building ,�Ulii/ e�.il7�'JPLY '�..t�'SlP�ElVi�Z HEAT SOURCE: <br />Proposed Use of Building %V� �C�"f%�F .io� Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse X' 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 />!'�-��ai� 0/2 t�, v r�L K. f� � O %%�`� hr,5' PF- i7'�" ��'" <br />f� 3 r��v lr �I ro G: �- P�i r�� �.E s���ca���-�,�t �p-r�c�� <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />� Water heater <br />� Gas fireplace <br />� Gas range <br />� Clothes dryer <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />� Woodstove <br />� Ducting <br />� Other <br />SPRINKLER / SUPPRESSION <br />I Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />� Lavatory (wash basin) <br />Kitchen sink & <br />Dishwasher <br />Clothes washE <br />Water heater <br />Sink (service/t <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 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 taw regulating 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 />/ � 2�21� �3 <br />Owner Authorize Agent Sig ature Date (Revised 6/2012) � <br />1 � <br />