|
r�
<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: , p I C%r; � fJ, �'_%i� PR�PERTY TAX # PERMIT #
<br />�:i t l (,,' � l�,/ � �'t ' �,' . 7 `'r
<br />�'l
<br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br />OWNER L 1����iti,,� b�C'ji�f�t� ����[:.��{� ��Vl����, � i �.(- Phone/E-mail t �- ,
<br />i � 115� �c'' �1�',� �
<br />Address , � � ����'��� � c �l- , jti �� �_� f'r���' �l � �ti�,%� `%�'���%� d City/StatelZip
<br />APPLICANT: _ Owner _ Owner's Agent � COIlff2Cf0� _ COf1t�8CtOf S Ag2flt _ T2f18f1t (must provide a letter of consent from the owner to do work in the space)
<br />CONTRACTOR i�L��� �-n''_'"�''�'��<<�J'���"J i L& I Lic. # ���L�� �} L- L�� %.S J!) COE Bus. Lic. #
<br />2 `� �. -{� 1..� t a �"r�✓ ( j r ,.�/, ,z � � .�
<br />Address , �S �� ,.S �. � . -S ► ! ; S /`- wS � Q../,q- C� Phone/Emai � S� 3 �� - �t E3 "
<br />ijY'.
<br />TENANT BUSINESS NAME CONTACT FOR PERMIT ,
<br />Ci C� Z�' � YCC� ,�Y✓j�L�
<br />'�1��� ✓'F���;r ��"� i�l�� J; ) � � Gi ��?"� : �c'-y�,_ ��:1.�-t'-r��� .�-/-��
<br />Phone/E-mail 7iU �(2_ �i 3 � ,� v�C���'r`�� �Jy�dcC4�h{
<br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK %C�, GC%(.1 : C'�Ci ��,^<°� % .f
<br />� 't t/., � t..Jt L�
<br />..` + \.1�..�� I• '�:�.II�L: l:°.';S 7..., C' ( i. J
<br />Existing Use of Building � I`�� �� i- �� �� � I�� HEAT SOURCE:
<br />Proposed Use of Building ���� �`''' ''' `�' �^� ��-c, l) t.'���j J�4 C � �� I/ Gas Electric Other
<br />l
<br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family x Commercial
<br />Type of project: New .n Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use
<br />DESCRIPTION O� WORK (additional space provided on the 6ack� : �� � ����� ,�� :�>� ��� j `f � ,��� -C � t ��� ;; ;, � � �� , i �� v�Z<�
<br />,,��� /����",�i,>���c ��c'CC���i��„�,,�,��C,�v=-� t-�.t.; �, }7 �� r-�''v,-,��v�L1�� �6 �L'��5��,���C c-vi�'��'Y �.;
<br />y.t.� �c.�C�' ��� 7- C; ,�' ,- }, j�'vY,�1' (y �{- 7 '
<br />�� ��' � � � � � � � ��) � � 0� I � vv, J � /� nf �7 �"S� �
<br />. � i � i, � �.. ' , V, ii. ` S�f%�1'�t� SJ�:,;
<br />c, - I - f
<br />t �� �
<br />L�J1 � � , r�� -j _�, ��i Y>1 �) � l,_ , ��j� �� 1'l'��, (� �i_� �.� ���c. � � , -� ` �,+" 1
<br />� � � ��,� � � �, > �'�r'
<br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br />Show Number (#) of fixtures Show Number (#) of fixtures
<br />� A/C — air handling units Toilet
<br />� Forced air systems Bathtub
<br />� Gas piping Lavatory (wash basin)
<br />� Water heater � Shower
<br />Gas fireplace � Kitchen sink & disposal
<br />Gas range � Dishwasher
<br />Clothes dryer Clothes washer
<br />� Range hood Water heater
<br />� Exhaust fan Sink (service/bar/mop/etc.)
<br />� Heat pump � Backflow preventer
<br />( Unit heater � Urinal
<br />� Boiler Drinking Fountain
<br />Refrigeration � Floor drain I
<br />Woodstove � Grease trap '
<br />� Ducting � Roof drains
<br />I Other I Medical Gas
<br />SPRINKLER / SUPPRESSION SYSTEM I Other:
<br />INumber of Heads Other:
<br />I hereby certify lhat 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 noL The yranling of a permit does not presume lo give authority to violate or cancel the provision of any other stale or local law regulating construction
<br />That I am aulhorized by the owncr of lhis property to per(orm the work for which application is made and I comply with lhe Slale Conlraclors Law 18.27 RCW and 296.200A WAC.
<br />/ //�-j
<br />',�'�)�,5�' cz:,.ti��,C� ..�C�S)� J r.�`;'�i��/S
<br />—� > ,
<br />_ __ � C; cl / � `� � � �� y.� � v �S�U,-� �y w � � �—� �� � �"1C'.
<br />OwnerlAuthorized A�e Signature Date �\ (Revised 6/2012)
<br />��' �� �� � � ��,� ��,��-,� �S , ���
<br />� I �✓��/ V�( `L _���C� (l �j L�Li r� ��. �� � Z
<br />
|