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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 />�� f APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: PROPERTY TAx if P MIT # <br />� 28n���. 3o�gb� � ► 30 - o <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER�(�� � T/ws'� Phone/E-mail 4ZS=2G1- IOOD �it.i-2G1- /�ei <br />Address 'j,'Z,� ��R,��( (',�,� ��w City/State/Zip r,A� W,4 �j=,p <br />APPLICANT: _ Owner _ Owner's Agent ]� Contrector _ Contractor's Agent _ Tenant �mUsc Pro��ae a iener or con5enc rrom me owner to do work m�r,e sPa�e> <br />CONTRACTOR ��,,.� L& I Lic. #/4 'Z! p/C COE Bus. Lic. #(7/ <br />Address '�$SS 5, '2p6� $T �� �%�$Z, Phone/Email 2s3�Q'�2• "7ZZ,Z <br />TENANT BUSINESS NAME CONTACT FOR PERMIT I <br />��C1� ��I��y^R.e� / <br />� ��, Phone/E-mail ��� K �, /2w�.dN.Go <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � 4'� � <br />Existing Use of Building �,i.�yfFlt£ ,a,.tisf' � O'����c.G HEAT SOURCE: <br />Proposed Use of Building �ji4►�E 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 />AAp S JJ�� Q�%��rt SpR1�JKL�'ltS 1 h o���tti s�►CE <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 pipin Lavato (wash basin) <br />Water heater Shower <br />Gas fireplace Kitchen sink & disposal <br />Gas ran e ; Dishwasher <br />Clothes d er Clothes washer <br />Range hood Water heater <br />Exhaust fan € Sink (service/bar/mo /etc.) <br />Heat pump € Backflow preventer <br />Unit heater Urinal <br />Boiler Drinkin Fountain <br />Refri eration Floor drain <br />Woodstove Grease trap <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 ihe same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specifed herein or not. The granting of a permit does not presume to give authonty to violate or cancel the provision of any other state or local law regulating construction <br />That I am authonzed by the owner of this pro to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />7-30 -� 3 <br />wnerlAuthorized nt Signature Date (Revised 6/2012) <br />