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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 ww�v.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: � �. PROPERN TAX # PERMIT # <br />I(�IS �� � Jfi r5(,L' �.,,-��e Z�c� 2.' �' I(iL� I� I�QG� r�ti� ( � ���� �G' <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER ����)��� Co� , Phone/E-mail <br />Address �O � {` � �, ��{ '(,�,� # 7]�,: City/State/Zip i;�� / G�;`/ /���1� � <br />APPLICANT: _ Owner _ OwnePs Agent %� Contractor _ Contractor�5 A92f1Y _ Tef7aflt (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR C1= N� �-I �,�,�c• C1�ti� ''; I� f�< L& I Lic. # C�. �%�� �I ��iC,�' '�, " COE Bus. Lic. # L' `l J`�5.3 <br />Address �1�. (�;X ��ZL.j � �j�Y�Ic;1/��. �L:.'I. �1��1�� Phone/Email`�Z7"cSG/•/�'i�j�,,f�(CtN.�.�-'�F,^1�iiV�'-iC�Z, �,;Vl <br />TENANT BUSINESS NAME CONTACT FOR PERMIT -r' <br />jereru � ! oelley <br />.:T �iT T� � �, , <br />Phone/E-mail �t L� -CG �- I z`I j ��E,r e'�YW� ('i=,�i "�il�;�1.12- ��.M <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ;� J 5 CC' • t'�' <br />Existing Use of Building � o� HEAT SOURCE: <br />Proposed Use of Building ����L�1 Gas Eiectric i� Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family .i� Commercial <br />Type of pro ect: _ New _ Addition X Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) :�-�5� �� � � /�ew �'�q�/ y�p,� ��� �!� t U-G'�'�, U�/�� <br />� i � � �'C `� lC' � �\C "v � �-! ('f� r <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn X 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 drver <br />Exhaust fan <br />Heat pump <br />Boiler <br />; Refrigeration <br />i Woodstove <br />Ductin <br />( i Other ' 'v b�x <br />SPRINKLER / 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 />Backflow preventE <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 goveming this type of work will be complied <br />with whether specifed 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 authorized by the owner of this property to perform the work for which application is made and I comply with the State CoMractors Law 18.27 RCW and 296.200A WAC. <br />) <br />7 l <br />' .�c,,�' %�'/�� �������� �2�i�'-/y <br />Own Authoriz�el A ent Signature Date (Revised 6/2012) <br />