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0 <br />• <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 />E ADDRESS: r PROPERTY TAX if PERMIT # <br />� � ,, �; i C�'C% /-1 , � .. � ;� J �r,; ��::1 car,��..��._� 7�- n l,� i �r��S -D l�`i <br />for new construction: Short Plat/subdivision <br />ER <br />LICANT: �Owner �Owner's Agent <br />CONTRACTOR <br />ress <br />Lot No. (attach copy of long legal description) <br />hone/E-mail �.�� �' � � � ���%� <br />City/State/Zip <br />�7� <br />Contractor _ Contractor�S A9@f1Y _ T@Ilaflt (must provide a lelter of consent from thz owner to do work in the space) <br />L & I Lic. # <br />Phone/Email <br />COE Bus. Lic. # <br />TENANT BUSINESS NAME CONTACT FOR PERMIT � ? <br />�-� C��.�'--� i� _S �� c, E.,1�_C�� S c LL,�•��^�4� � �--e _S Li � �' �C_.�7�-�--J I�- i�-%?CL� �� <br />Phone/E-mail � ' r., is,1�;,. C <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building �.l`�� �1'���� �`� � i � i�/o ��� (- HEAT SOURCE: <br />Proposed Use of Building Gas_ Eiectric Otner_ <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 (additiona/ space provided on the back) : � <br />S�-� ��c` C. ����� "-�-� t'` C� ct.'� � C� �/ C l!� �� b ll1 �w G <br />� � c-f- � ��-�, t�_ ����C°{ ��� � i..� �,-�(�s ce is�`� I e l�1� <br />� .0 I� P��� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIOy <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 />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />RefrigeraUon <br />Woodstove <br />' SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />Toilet <br />Bathtub <br />Lavatorv (wash basinl <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc. <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />n� <br />I hereby certify that I have read and examined lhis application and know lhe same to be true and correcL All provisions of laws and ordinances governing this type o( work will be complied <br />with whether specifed herein or not. The granting of a permit does not presume to give authoriry to violate or cancel the provision of any other state or locai law regulating construction <br />That I am auth zed by the owner of is prope y 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 />� j�- -, <br />0 ner uthorized Agent Signa ure Date (Revised 6/2012) <br />l�Z <br />