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� • <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 />SITEADDRES : - PROPERTYTAX# P RMIT <br />� - j "l;t E � ���',3i; � c �' � �`¢CG C�� c�e.�— �: �' �� <br />LEGAL for new co struction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />� - „7 <br />OWNER ' "1 / , ' 7 Phone/E-mail ,� — 1�� j <br />Address � � City/State/Zip *' / % f , l � � <br />� � � c � �Z�F� � ��r'� "� <br />APPLICANT: _ Owner _ wner's Agent _ Contractor �COf1tf8CtOf'S Ag@nt _ T8llallt (must provide a letter of consent 6om the owner to do work in the space) <br />CONTRACTOR �/7// �'J�� 11 y7G�l C% State Lic. # �'� �l'J %-� � !City Bus. Lic. # <br />� /l�I 1 ' , / ; � / �L�' < < —/�:�-� <br />Address �/ � �y�— � �. i(.�i"GLi' 4"�, � ��L' .. Phone/Email ) - r�. - -E-�� t _C.". C�-i"y� <br />TENANT BUSINESS NAME CO TQCT FQR PERILIT ��L.ZG��'u`�' ��I!-1 /`��/�E Z <br />r � � <br />/"1li.r�'lrr�� iv� /'�C: f`.=�'l�>�e� <� C� rC/ �� c`% �� �?�-7 , <br />Phone/E-mail �.��Jj�:' �-' `[,�;3 � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK�, �!a�. /b� <br />Existing Use of Building c�r7 � � HEAT SOURCE: <br />Proposed Use of Building Gas Electric Other <br />Building type:.�Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />T e of ro�ect: New Addition Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br />, WORK (additional space provided on the back) :. � / <br />D��R�PT�,ON T F'al/'1C�Q f7C'3'� �j �� /(/';�L �� b� ,t /7f?C f w J��2.1 t.L�.jClS�7�Z� 7Z; ? 1<-x"%�c�-� ?�%>'l <br />� � <br />�� S �— �. �,r c�d� � � � �,«.�� ,�`-/ � lc c:�S <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: \ New _Addn _Alteration _Repair Type of ProjPCt: _New _Addn _Alteration _Repair <br />Show Number # of fixtures ` how Numbei # of fixtures <br />A/C — air handlin units Toilet <br />Forced air s stems Bathtub <br />`.Gas i in ���Lavato wash basin <br />VVater heater Shower <br />Ga� fire lace Kitchen sink & dis osal <br />Gas 'ran e Dishwasher <br />Clothes`dr er Clothes washer <br />Ran e hobd Water heater�, <br />Exhaust fan �,� Sink service/b� mo /etc. <br />Heat um `� Backflow reventex inside bld <br />Unit heater '1 Urinal <br />Boiler ` Drinkin Fountain <br />Refri eration Floor drain <br />Woodstove Grease tra <br />Ductin Roof drains <br />Other Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. M provisions of laws and ordinances goveming this rype of work wip be compl <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 arn uthorize�d by the o ner 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 />���� i � _ - _ � � <br />'�.�� <br />Ov�thedAbthorized g nt Signature Date (Revised 4/2015) <br />� �� <br />