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�n2umr,nA rn1SS�owt r-t�o�OS 't�. <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 />SITE ADDRESS: PROPERTY TAX # PERMIT # <br />63 0l 36r� .4vr_ �✓ S� l30 2�O�trr 3 aaG10� &00 K ISON ~ 00 2 <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER Poti✓der /''irlls LLG Phone/E-mail <br />City/State/Zip <br />APPLICANT: _ Owner _ Owner's Agent (� COf1tf8CY0� _ COf1tf8Ct0l�S Ag@f1Y _ T@f1211t (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR Pa�rr2f Fiy'e Pr�te��r�j-r �& � ���. #�ArRrFpoqRGF COE Bus. Lic. # QZN�RK <br />Address ZZ�7 zaT"f}vc E Fr�'e �A ���2-/ Phone/Email .c s 3— q�' �2 `� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT Ohrt Da�o� <br />G,-�►r� a,/�l rssrvn ! DOa,S Phone/E-mail U O%11 D@/�a�'i ►vTT�- ��^'� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 2� D'�'%G•�O <br />Existing Use of Building Wa�'L.° yf�''i�td'� <br />Proposed Use of Building W�/L' �8 �oi+'t-rGPi Gas <br />Building type: _ Single Family _ Duplex _Townhouse _ Mu��lti- amily �Commercial <br />Type of project: New Addition Remodel Repair �' T.I. _ Sign �prinkler _De <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />HEAT SOURCE: <br />Other <br />Chanqe of Use <br />,�I odt � �•� �earps-,��r- Sprn� kle�r s�rt�e� f� �� w der� rs�ry w�ll a�d <br />�l T2eS . <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 />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeratio <br />Woodstove <br />� Other <br />INKLER / SUPPRESSION SYSTEM <br />� � Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <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 />wilh whether specified erein 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 construclion <br />That I am auth ' ed the owner of this property to perform the work forwhich application is made and I comply with lhe Slate Contractors Law 18.27 RCW and 296200A WAC. <br />� G-�-._ � � "1 I }"' <br />Own r/ uthori nt Signature Date (Revised 6/2012) <br />�`Z <br />