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�a-:� � ��-- � • <br />Y <br />��� Z � �-�l"Ss� 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 />SITE ADDRE PROPERTY TAX # PERMIT # , <br />� j�. �� CI11J y� I lt- �D� <br />LEGAL for new constructio : hort Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER �S ��� �• Phone/E-mail `�2,5 S�.�� � 4- <br />Address �, � City/State/Zip <br />APPLICANT: � Owner __ Owner's Agent _ Contractor _ Contractor�S AgBflt _ T@fl8llt (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR � �`� �Cc/' t��� State Lic. #�� 1V! � L� �L City Bus. Lic. <br />Address� � C;� �� !�%lil/ �; c�' %. . C� �v ' Phone/Email .S �' � _ 'r�r � ��' � <br />TENANT BUSINESS NAME C NTACT FOR PERMIT U�,/���,��— <br />Phone/E-mail �-f� � ��. _ �" - C�� , ��v� �/I�.�C� �'1 <br />BUILDING PERMIT AP�LICATION CONTRACT PRICE OF WORK `�� ,�..� <br />Existing Use of Building ��L;i4,� HEAT SOURCE: <br />, <br />Proposed Use of Building�C�l� �`'.`�n �' "1a �1�f �� � j� �Jx' Gas_ Eiectric_ Other <br />Building type: � Single Famil�lex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition � Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : . <br />�U;�n,vt> c� �v��le� �'►,a �c 1�� ( S,vte� �v�� ��, ��v�'� \N� ���� /�t`�.'��C.c�'1. <br />C_ �� K � rz i� i'4 <br />��r,r�t,���_- �� � �t���,+{�, r�� � r.�cr si�k ��'� i����r _s��� . <br />;r,(t{ � � n"��U``k_ ������ , 1 � <br />c 7i��. <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICA'�ION <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 />i A/C – air handling units ; Toilet <br />( Forced air systems i Bathtub <br />' Gas piping � Lavatory (wash basin) <br />� Water heater � Shower <br />i Gas fireplace ! Kitchen sink & disposal <br />I . Gas range Dishwasher <br />;' Elothes dryer � Clothes washer <br />� Rai�ge hood ; Water heater <br />� Exhaust.fan i Sink (service/bar/mop/etc.) <br />; Heat pump�, � Backflow preventer <br />Unit heater °�, I Urinal <br />'; Boiler ` i Drinking Fountain <br />� Refrigeration ! Floor dr3i,n <br />', �Noodstove I Grease trap�� <br />! Ducting � Roof drains <br />� Other j Medical Gas <br />SPRINKLER / SUd�PRESSION SYSTEM j Other: <br />� Number of Heads ! Other: <br />I hereby ceriify 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 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 Contractors Law 18.27 RCW and 296.200A WAC. <br />�� � � <br />wnerlAuthorized Agent Signature Date � (Revised 3/2013) <br />