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PERMIT APPLICATION <br />� <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 DDRESS: PROPER TAX # PE MIT # <br />i v�' c��f-� -�iG'��r� �� u�� ;���s' �� D '' � � "'����UC �!,� - i�' <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER � i JiJ� Phone/E-mail �zS� - 7s�-66� ���.s.:�r��>-i�� 6 <br />Address � v r`� �'LF S� � C[�� City/State/Zip -- %� �' �9- � 2(> r <br />APPLICANT: U�' Owner _Owner'SAg@�t _CO�t�BCtOf _COflt�act0�'sAgent _TEnant(mustprovidealetterotconsenttromtheownertodoworkinihespace) <br />�. <br />CONTRACTOR c=�-'li_ '�� � 2' ,' T/l�C • L& I Lic. # COE Bus. Lic. # <br />Address .j ;� � ��Of�L{,/� � f fj(� � `� 2 " Phone/Email <br />TEN �NT BI�,S�N � S NAME _ C JQAII CT FOR PERMIT �� �y�� �nn� ryJ��,`� fQ���/'�� C G�, , <br />� fh �, ,3 .:; � rj r T <br />�- 7 7^� � t i�: Phone/E-mail �1f" yJ/ -�� �f �{ z f"2�l "i! % Z� <br />BUILDING PERMIT APPLICATION CONTRACTPRICEOFWORK -�� C�0 � <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric_ Other_ <br />Building type: � Single Family _ Duplex _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 />,,;=j',��/��v�`���11� �<l/ ,�% /`C� ��'� � ,4'"C/�'� l�/-�1��/ <br />� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteretion _Repair <br />Show Number (#) ol 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 <br />Woodstove Grease trap <br />Ducting Roof drains <br />Other Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads Other: <br />I hereby ceRfiy that I have read and examined ihis 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 granling of a permit does not presume to give aulhority to violate or cancel ihe provision of any olher stale or local law regulating construclion <br />That I am authorized by the owner o( lhis property lo perform the work for which applicalion is made and I comply wAh the State Conlraclors Law 18.27 RCW and 296.200A WAC. <br />�� / Zv -�3 <br />OwnerlAuthorized Agent Signature Date (Revised 6/2012) <br />1( � <br />