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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUNi�ING/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 ADDRESS: <br />5 l� ^ %`i"� � S��% . I=Vt=2�z� <br />LEGAL for new construction: Short PlaUsubdivision <br />OWNER S� SS V �� 5 T��2y I�' �/��! <br />S�\ � <br />Address ` � t�- h � �j �,t,) L � � r <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ <br />CONTRACTOR t�'i �� � �= <br />SINESS NAME <br />PROPERTY TAX # <br />C• a 7 c'� �c n <br />Lot No. (attach copy of long legal description) <br />) L, Phone/E-mail ;. Z. -- �� a -" ' "� <br />City/State/Zip <br />COf1if8CtOf�S A9811� _ T01l8f1t (musl provide a letter of consent from the owner to do work in lhe space) <br />State Lic. # <br />Phone/Email <br />BUS. �IC. # <br />Phone/E-mail <br />BUILDING PERMIT �►PPLICATION CONTRACT PRICE OF WORK '�I I 7i' <br />Existing Use of Building S�Ncs-i-� ��l����� d2�S��c.=i�Z��te� HEAT SOURCE: <br />Proposed Use of Building N(� C'r[ %�N C� Gas Electric Other <br />Building type: i/S�ingle Family Duplex Townhouse Multi-Family Commercial <br />Type of project _ New _ Addition _ Remodel '_ Repair __ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTIO'�I OF WORK (addition<,I space provived on tne t�acHj : <br />� C e i r't� � C� L� �= X� ST (�h1 C: Zr N� i— ��:30 2 17 � L� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />� Forced air systems <br />j Gas piping <br />Water heater <br />Gas fireplace <br />� Gas range <br />I Clothes dryer <br />; Range hood <br />� Exhaust fan <br />Heat pump <br />Unit heater <br />! Boiler <br />I Refriqeration <br />� Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />� Toilet <br />I Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <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 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 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 />Tha �n authorized by the owner of this propeRy to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />l aLt� v t, �� G� 1�'C,'fn- /�'L''� G..% �� <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />