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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.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: '�" � �. Y.i.v!' �`�C— Z-�Q` _� 1 C� �U ��:D II EJ IIT� V�'(l�' il G� <br />1 �2'l l 12 Si .�- �� <br />for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />Owner _ Owner's Agent <br />Phone/E-mail <br />City/State/Zip <br />ContractoPS A9@Ili _ T@f18�t (must provide a letter of consent from ihe owner to do work in the space) <br />CONTRACTOR �}-�(�S"S �Z/�.SZ, F�tL- L& I Lic. #�✓'��C �"��,.(-I COE Bus. Lic. # <br />Address �,iJ�LI��-LJ `%a�jc_. SC � S,'�2� �Y^^'�S CJ�/!� ��� L�"�,,6 Phone/Emai���U���'Z��Li �Cl `� �✓�ST���.`�SC J-r <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />�}l �./' �-°- �� i�`'- � � `� 'l <br />�-'L 5✓ .'C�� ZC US" � L 3�,5 � � , - <br />� � � Phone/E-mail --(^ �,�''� i c�i��--tnS�� ,;`L .,, "", u/ <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building <br />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� � �n <br />/ _ `'" "' ` '�L'� � ��L—�� _.�r_, v'� �j,_ Lv� �.,�2-J � a 'n"ti� �P�✓ � y �' �� � <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Forced air svstems <br />Water heater <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYS <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dispo: <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mo{ <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medicai Gas <br />Other: <br />Other: <br />I hereby certi(y that I have read and examined this application and know the same lo be lrue and correct. All provisions of laws and ordinances goveming this rype of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume to give aufhority to violale or cancel ihe provision of any other state or local law regulating construction <br />That I am auth ed by ihe owner of this property to perform the work for which application is made and I comply with the Stale Contractors Law 1827 RCW and 296.200A WAC. <br />.—,L�_ (c <br />Owner/Authorized Agent Sign ure Date . (Revised 6/2012) <br />