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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 />SITE ADDRESS: <br />10o Y �r�Z th sr. S_L 13�-UGG— <br />LEGAL for new construction: Short PlaUsubdivision <br />PROPERTY TAX # <br />No. (attach copy of long legal description) <br />WNER �c�:^-+ � �� � 0� C G l''%�U /ZLA�T, Phone/E-mail �a s�- 7�s -� �ta � <br />ia�ess '> / � i � �- t%i � f , w City/State/Zip L ,,� , � ,,,, �,� �.� l�✓/� y' ,� �; : 7 <br />PPLICANT: _ Owner _ Owner's Agent �Contractor _ Contractor�S A9BIlf _ TOflaflt (must provide a letter of consent from the owner lo do work in Ihe space) <br />CONTRACTOR Z. c> ��' P/ �c :� 6�•� �� <br />Address % � / � � �fi 5 t. S L ijc� <i � %/ <br />TENANT BUSINESS NAME <br />BUILDING PERMIT APPLICATION <br />State Lic. #�; C'•� % 5 G Y'C [' � I City Bus. Lic. # <br />i�//j %�°t' � � Phone/Email `'� �S -G QG � �C'� <br />CONTACT FOR PERMIT <br />n ../ / <br />� O Ci c i �.- i,� l� /� C_' �/ <br />Phone/E-mail '�;� � � , ,S (, v2 � U / <br />CONTRACT PRICE OF WORK <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />Rep���e �-�����- �-�.,�� {'�,.- � �,,. f �: <br />�c�, a��t �3�� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />I Forced air systems <br />i Gas piping <br />i Water heater <br />Gas fireplace <br />( Gas range <br />Clothes dryer <br />Range hood <br />j Exhaust fan <br />� Heat pump <br />; Unit heater <br />� Boiler <br />; Refrigeration <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />HEAT SOURCE: <br />Gas Electric Other <br />Demolition Change of Use <br />f�� � U 3� �� <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />Lavatory (wash <br />Shower �'� y <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Sink (service/bar/mo <br />Backflow preventer <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 this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be con,piied <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 am authorized by the owner of this property 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 />�'V <br />Owner/Authorized Agent Signature <br />Date <br />(Revised 3/2013) <br />