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PERMIT APPLICATION <br />�UILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLII"B�� <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 k 2(� (� y� Z I P �RMIT # <br />1`� W �--1 \� �� ✓5, C�.� 1.2� ���Xa ci' � 2 ' V� � ���� �� <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />NER ��'d n �-� � � �jM�^�n ��'�-��•,avtS IPhone/E-mail <br />ciress �O �j�c- \(� ?] ICity/State/Zip ��(Q.�� � Q� ZCI (� <br />1 <br />'PLICANT: _ Owner _ Owner's Agent '� Contractor _ Conlractor's Agent _ Tenant �n,��5i i�rovide � ieuer or conser�i rro�n tne o�vner to do won< ��, u,� s���,�e; <br />CONTRACTOR v�,n ,.� �Gn� o� 1 L& I Lic. #,, ,�}�µ COE Bus. Lic. # U2427 <br />, \ e i 1 1- � cc,�7 � I� 22� b <br />Address �� b�l 1L1�1'�^ f� �� � ✓'�� � \ �'�'.�! ^ �!�!. Phone/Email �Z� � � <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />�T(.�n��Q.j �✓�.✓��nnlC�\ !>v� S Phone/E-mail �J �VG1 � "I��SZ / _ �"L� <br />8�,lILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �' Yi � <br />Existing Use of Building '�,�1,� CO� HEAT SOURCE: _ <br />Proposed Use of Building ,s °l ✓'"�'C- Gas_ Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family �Commercial <br />Type of project: New Addition Remodel _ Repair 76 T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provicled on the bad<) : %1 <br />� �lI I �-L `� \ �C a2 i Gt �5 � M cjci � �� e�?C,1 �` � `� �v`c �v-1cJ2—�'�'_ � � !� S-�A � � � ( � � �P� <br />� � �r� S�CS � .� Q �� G� ��-1' D-�l'"� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn �Alteration _Repair <br />Show Nurn6er (#) 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 />Y Exhaust fan <br />i Heat pump <br />Unit heater <br />' Boiler <br />Refrigeration <br />Woodstove <br />� i Ducting <br />� Other �TJ'� L.t- S <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />PLUMBING PERMIT APPLICA`� g�'au'� <br />pe 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 (servicelbar/mop/E <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 ceiiify 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 o( work will be complied <br />with whether specified herein or not. The granting of a permil does nol presume lo yive auihoriiy to violate or cancel ihe provision of any other state or local law regulating consVuction <br />That I am authorfzed by the r of this property to perfonn the work for which applicalion is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />5�� ,3 <br />t�Z <br />Own rfAut ¢e Agent Signature Date (Revised 6/2012) <br />