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• <br />PERMIT <br />APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SER'VICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 42�i-257-8857 www.everettwa.org <br />SITE ADDRESS: PROPERTY TAX H PERMIT # <br />�,0 /n� �'t2i 11,4v a4��� . F_ �/P✓p /�' I�,r,�c� �;Il� + � C � �• — C'i . _ � , <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />� <br />Phone/E-mail 56.�(/ a''�z+"l.Y�'� <br />�dress p� ��y� ��pq,�y�' p/����y� �,�f��,� �City/State/Zip <br />PPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent � TEf10fl� (must provide a letter of conseN from lhe owner lo do work in the space) <br />R <br />Address � � � � �%' � �� � �, <br />TENANT BUSINESS NAME <br />� �/�� ��a �4'���� <br />BUILDING P�RMIT APP�o1CATI4N <br />State Lic. # <br />� . Phone/=mail <br />CONTACT FOR PEF:MIT <br />Bus. Lic. # <br />0 <br />Phone/E-mail �,o�j � ��.� '� <br />CONTRACT PRICE i�F WORK <br />E�isting Use of Building � <br />Proposed t)se cf Building <br />Building typz: __ Single Family __ Duplex =Townhouse _ Multi-Family _ Comme�rcial <br />Type of project: New Addition Remodel Repair _ T.I _ Sign ___Spr'nkler <br />DESCRIPTION OF WORK (addihonal space prowded on [he back) : C'����(�� � �'�' <br />� 4 <br />t � <br />C�IECHAI�ICd►L PERMIT APF'Ll�A710N <br />of Project New _Addn _Alteration __Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />I, Forced air systems <br />; Gas piping <br />j Water heater <br />j Gas fireplace <br />� Gas range <br />Clothes dryer <br />Range hood <br />j Exhaustfan <br />'j Heat pump <br />i Unit heater <br />' Boiler <br />� Woodstove <br />Ducting <br />� Other <br />SPRINFELER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />Ga <br /><?.i�'CY1A <br />Electric Other <br />ion Change of Use <br />�- . >,,, ,-� .� <�� <br />PLUM131NG PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />ShoN Number (#) of fixiures <br />� Toilet <br />! Bathtub <br />j Lavatory (wash basin) <br />i Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heaier <br />Sink (ser��ice/bar/mop/etc.) <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 thal I have read and examined this application and know the same ;o be true and correct. All provis�ons of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permil does not presume to give aulhority to violate or cancel the provision o( any olher state or local law regulating construction <br />That I am authorized ihe ow r of this property lo perform the work (or which application is made and I comply with the State Contractors Law 1827 RCW and 296 200A WAC. <br />� <br />� o� 1 �w� <br />Owner/Authorized Agent ignature Date (Revised 3/2013) <br />