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� <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 425-257-8�j57 www.everettwa.org <br />I(--(�,(i ( 5i Ti�1 T�� �. 1�.� 1� <br />SITE ADDRESS: y � <br />' �` � � % :�, r� u! "� � `J k— <br />LEGAL for new construction: Short PlaUsubdivisio <br />OWNER �`�17� � r�t�;��l <br />Address `�.t � Y..� �� <br />APPLICANT: _ Owner _ <br />CONTRACTOR �I�,� \;� <br />Address r' j � t( �-tj��,�I � <br />TENANT BUSINESS NAME <br />TAX t� <br />PERMIT # <br />No. (attach copy of long legal description) <br />� <br />� Phone/E-mail � �;� • �?f ;jj � � v���(f'i.:�Ci(�� f/ I �J; • n '� <br />v <br />ct �j-�1� i��" �.? v�.% City/State/Zip j�,t-`-- � � ��� �)c6 ) �'- . <br />Owner's Agent � Contractor _ Contractor�5 A9Bflf _ T@fla�f (must provide a latler of consent from the owner to do work in lhe space) <br />'" I('�� -L� r fJi: �%_ State Lic. # t}>�.._i;; .�: �.�` ��i V,JCity Bus. Lic. # <br />�7 �.j r1 n ,t <br />;) I , \��. � ��<=c. � I ' ���IJ �� 'i �I� Phone/Email <br />CONTACT FOR PERMIT <br />�..___ _--_ __. Phone/E-mail �-� .r�-.:; `1 �� � �>t�) Z -..� <br />IJ <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � f-; C�C� , CC�` <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric/`'� Other <br />i <br />Building type: -�.Singie Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition �Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRI TION OF WORK (additional space provided on the back) : <br />�l � �I -� C� t �� � U.v � �C� ��� �.;� t �- � �+��'l �.' � : ��`� C�1 '�G c�P� �� 1 � k� �-�� ��l �v � \,�%d'�'% <br />� � <br />\ r� S ti G�C.G�- �` P_ I C�- r � c_ -���r'���G�C.--�_ <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn �/�1lteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />�-�i i Forced air systems <br />j Gas piping <br />j Water heater <br />I Gas fireplace <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />� Other <br />SPRINKLER / SUPPRESSION SY <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />i Toilet <br />i Bathtub <br />j Lavatory (wash basin) <br />i Shower <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 />with whether specified herein or not. The granting of a permit does not presume to give authority lo violate or cancel the provision of any other state or local law regulating construction <br />That I am a thorized by he owner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br />,,�� � <br />,i ,// � '//��/ 1� ,� _ � J _ � .3 � <br />,: � � 1 <br />O er/Authorized Agent Sig ure Date ��r�� (Revised 3/2013) <br />