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� • <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERM�T SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ADDRESS: <br />LEGAL for new construction: Short Plat/subdivis <br />PROPERTY TAX # <br />PERdAAJTa#� � � J <br />11 <br />No. (attach copy of long legal description) <br />OWNER , � �. � F„ . �,, - Phone/E-mail <br />Address '� � ���r,__ City/State/Zip <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�5 Ag211� _ T@Il2flt (must provide a letter of consent from the owner to do work in the space) <br />� 1 i <br />CONTRACTOR �, � �J Yj Y� � L � State Lic. # � �- L � r � � City Bus. Lic. # �%'{ � �� <br />Address Z, 2 �� i+� —� • C� �'�''��� Phone/Email � C�� <br />TENANT B�5INESS NAME CONTACT FOR PERMIT ��n�.�� �U rl� S ca n <br />1 <br />Phone/E-mail � 2 � Q <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building �eG�t'►! i <br />Proposed Use of Building �� 5( ��.� � � <br />Building type: ?� Single Family _ Duplex _Townhouse _ Multi-Family _ <br />Type of project: New Addition � Remodel Repair _ T.I. _ Sign <br />DESCRIPTION OF WORK (additional space provided qn the back) :�� P) y( ( <br />�! l�G� `���1 I�� yS G� � �y eJ ���- t'l y <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />5how Number (#) of fixtures <br />� A/C — air handling units <br />� Forced air systems <br />Gas piping <br />j Water heater <br />Gas fireplace <br />i Gas range <br />i Clothes dryer <br />� Rangehood <br />Exhaust fan <br />Heat pump <br />� Unit heater <br />� Boiler <br />i Refrigeration <br />I Woodstove <br />( Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />HEAT SOURCE: <br />Gas Electric � \ Other <br />Commercial <br />_Sprinkler_Demolition Change of Use <br />W �l �'� t r � E�:� V �� P Gl �'� U <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn � Alteration _,Repair <br />Show Number (#) of fixtures <br />Toilet <br />� ; Bathtub <br />� i Lavatory (wash basin) <br />j Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />; Water heater <br />i Sink (service/bar/mop/etc.) <br />; Backflow preventer <br />I Urinal <br />i Drinking Fountain <br />! Floor drain <br />I Grease trap <br />i Roof drains <br />� Medical Gas <br />i <br />�j � Other: i��,o�, ,Mp�� � <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 law regulating construction <br />Th�m 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 296200A WAC. <br />( ` _m.. <br />f <br />� �I , � ~ � - � I�" �r-i �� <br />. ' __._.._. <br />Owner/Au on .Ag�"nt Signature � Date (Revised 3/2013) <br />�--�•�.�/ <br />