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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 www.everettwa.org <br />SITEADDRESS: PROPERNTAXtt PER I # <br />z 9 yz �k>�� T,� �� r� j�'� �l' �. <br />LEGAL for new construction: Short Plat/subdivision Lot No.___ (attach copy of long legaf description) <br />OWNER LAl/}�f+ie.�l..�Jn✓ f4l�ya�_ O/= y/���,� (��,*�N Phone/E-mail <br />dress <br />City/State/Zip <br />, <br />APPLICANT: _ Owner _ Owner's Agent ✓Contractor _ Contractor's Agent TBf18f1Y (must provide a letler of consent frnm the owner to do work in the space <br />CONTRACTOR �-�.�/�iN$+)n� /�/ =rl�i3i,.� /� StateLic.# �J/�/ti-��-77'_�,��cyaUs.u�.#o��yuoy <br />Address J �'� �i U / � `f i��/ �t�t/C h�� /�-/1 / /.`-1,�I7�N �✓''� 3 Phone/Email �,u4� �c 7'�'� .;.�L � r=�2c -Ce>v�i <br />� /N1=Z L %LF� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />Mu�T� -i=�-n'"c-7 ,L/��..; ��.: �3ii...S4.:.- - � c,.�-Sc_. E <br />Phone/E-mail ''��-� S �-% �Y � `f� S � , �./%-d /� /�._-/�� � �.fl_= ..� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �-7�, "� � <br />Existing Use of Building <br />Proposed Use of Building <br />Building type: _ Single Family _ Duplex _Townhouse +�Multi-Family _ <br />Type of project: New Addition Remodel Repair _ T.I. : <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />/ �cr':� i..�-tt. t�'� �, t. S r'/z ��,�C t-� �'"1 S YS Tc= i'~, <br />�-;'7 /`� /�c=3� �%ir..�µj / � r:c <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handlin units <br />Forced air s stems <br />Gas pi in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes dr er <br />Ran e hood <br />Exhaustfan <br />� Heat pump <br />� <br />M Unit heater <br />Boiler <br />Refri eration <br />Woodstove <br />Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />�3 i Number of Heads <br />HEAT SOURCE: <br />Electric Other <br />Com�mercial <br />n ✓Sprinkler Demolitio <br />/ � �='-�_ �S : r� C. <br />of Use <br />/ 3 c. �`� ; , <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 />Sink (service/bar/mop/etc.; <br />Backflow preventer (inside <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby r.ertify that I have read and examined this application and know the same to 6e true and correct. All provisions of laws and ordinances governing this type of work will be compl <br />with whether specified herein or noL 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 wnstruction <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 1827 RCW and 296.200A WAC. <br />.� \��t/��� �L`�(C���S <br />Owner/Authorized Agent Signature Date (Revised 4/2015) <br />i�� <br />