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<br />PERMIT APPLICATION
<br />BUILDING/MECFIANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION
<br />CITY OF EVERETT PERMIT SERVICES
<br />3�'.00 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 ADDRES:i: PROPERTY TAX q
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<br />LEGAL for new construction: Short Plat/subdivision Lot No.
<br />(attach copy of long legal description)
<br />OWNER � :1_ r:, t r' ` -
<br />i�—��! �t�SCC�:r�c,. � ��<t_CE� _-�'.<,„;�- Phone/E-mail
<br />Address i"• �'. I�Z,X ?�C•�� `� r7 '
<br />City/State/Zip ,�� � 4-��� E� �; � � �'
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<br />APPLICANT: __ Owner _ Owner's Agent �'� COf1fC8CfOf _ CO�lhectOf'S Ag2�l _ TBfla�( �must provide a letter of consent from �he owner to tlo work in �he space)
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<br />CONTRACTOR (�i � • '
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<br />Address 6y.t'. �Y;X ��,�C'� � �, � '� � ( {: �'
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<br />TENANT BUSIP�ESS NAME CONTACT FOR PERMIT '
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<br />Phone/E-mail ���'�; ��-1��; i f���'r��ul� �'� c6�l�i•� la�� a.i� c�`t"��
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<br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �/5�'C� .��(i
<br />Existing Use of 13uilding il�� 1,: .,
<br />Proposed Use of Building � i �� �
<br />Building type: __ Single Family _ Duplex _Townhouse _ Multi-Family :�: Commercial
<br />Type of project: _ New _ Addition _ Remodel _ Repair k� T.I. _ Sign _Sprinkler
<br />DESCRIPTIOPJ OF WORK (additional space provided on the bacl<): :J ���.�;, f� `-1�,i�rt ,,`, , �! L;�;
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<br />MECHANICAL PERMIIT APPLICATION
<br />Type o _New_Addn \\ Alteration _Repair
<br />:ihow Number (#) of fixtures
<br />A/C - air handling units
<br />Forced air svstems
<br />0 _ Gas piping
<br />Water heater
<br />Gas fireplace
<br />Gas range
<br />Clothes dryer
<br />Range hood
<br />Exhaust fan
<br />Heat pump
<br />' Unit heater
<br />Boiler
<br />' Refrigeratior
<br />Woodstove
<br />vuc[ing
<br />Other
<br />SPRINIKLER / SUPPREcSSION SYSTEM
<br />Number of Heads
<br />HEAT SOURCE:
<br />+� Electric Other
<br />_Demolition Change of Use
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<br />PLUMBING PERMIT APPLICATION
<br />Type of Project: _New _Addn _Alteration _Repair
<br />Show Number (#) of fixtures
<br />Bathtub
<br />Lavatory (wash basin
<br />Shower
<br />Kitchen sink & dispos
<br />Dishwasher
<br />Clothes washer
<br />Water heater
<br />Sink (service/bar/moK
<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 lhis application and kno�v Ihe same lo be true and correcl All provisions o( laws antl ordinances governing this type of work will be complied
<br />with whether specified herein or not. The granting of a permit does not presume Io �ive aulhonly to violale or cancel the provision of any other state or local law regulating construction
<br />That I am authorizetl by the owner of this properry io perform Ihe riork (or which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
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<br />Ci< <� 1��`'al L �/� - � -�
<br />Ow-er/Aukh'orizgd Agent Signature Date
<br />� (Revised 6/2012) , ��� �
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