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P'ERMIT APPLICATION <br />BUILDING/MECFiANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIi SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />E ADDRESS: PROPERTY TAX ti <br />�-�U% � �v��I f�i/� �✓" j��i�t.c� / <br />� �YOy"U �Dv�Uc�`��'oc� <br />. for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />R � �����/// �a5� � �"'G Phone/E-mail <br />'�� <br />Address �08�/O for���If(�t/ y P .�4.'�L���� Gt�� 9r81Q� <br />— /��� �� Cit /State/Zi l! � U <br />APPLICANT: _ Owner _ Owner's Agent '� COf1lf8CtOf _ COf1ff8CtOf S A98f1� _ T2f18f1t (mus� provide a letter of consent from the ovmer to do v.�ork in the <br />CONTRACTOR �/i7I q� /� ry troK State �ic. # L�N/V % ��" <br />� / fC/- city Bus. Lic. # U� %(r <br />Address y�02, g �r f(/�% �u� �it,V,n �� � �Spp � Phone/Email 2 - % � - ��'�� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />!/i�! �-�'�f�Hil �p�� �-�7t7L-�� �r'�/�t✓l //GJQt/'1 J Sl�)c2',-7f�_ <br />�� (7—`_ Phone/E-mail��=7�/1 yyiver_rq r� N� . Co�..� <br />BUILDiNG PERMIT APPLICATION CONTRACT PRICE OF WORK /l, � '= <br />Existing Use of Building <br />T SOURCE: <br />Proposed Use of Building I Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair T I Siqn Sprinkler Demolition Chan e of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />/�s� l/ �� ) ���ca e ��'� � ,'�, �'-�� �,�G,,�sfi�'� s, ti��...,,, � <br />yas ���� ��.��cr-�� qril�es aw�o�{ �,.eq�,7�'-s, <br />✓ `/ <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Altera4ion _Repair <br />Show Num6er # of ��cdures <br />A/C - air handlin units <br />Forced air s stems <br />r Gas i in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes d er <br />Ran e hood <br />Exhaust fan <br />Heat um <br />Unit heater <br />Boiler <br />Refri eration <br />Woodstove <br />� Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />_ � Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of �xiures <br />Toilet <br />Bathtub <br />Lavatorv (wash basinl <br />� <br />�ioines wasn <br />Water heater <br />Sink (servicei <br />Backflow pre� <br />Urinal <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <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 compl <br />wdh whether specfied 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 />That I am au by t� ner of this property to perform the work tor which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� � <br />�—^• / G/ �%� /Z�/� 1 <br />Ow r/A zed A nt Signature Date <br />(Revised 9/2014) <br />