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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />4 DRE S: �L � P O ERTY T X# P MIT <br />�"i �2�� �C�, � . sc,u� � 1��1�co�o1 � i� � � r.� � _fr <br />1L for new construction: Stiort PlaUsubdivision Lot No. (attach copy of long legal description) <br />ER i-�V (�C.N ��f� l�--' ��ir t'1('_li(�'ti( hone/E-mail J1 C t�� M(� w�Sar�i�(L�IY�t`-9lil� <br />� - " LG�� <br />APPLICANT: Owner <br />CONTRACTOR W <br />Address ��� � <br />TENANT BUSINE S N/ <br />�-�n -I � _in ��� <br />J��% <br />Owner's Agent _ Contracior <br />0 <br />��SS �02- N� <br />City/State/Zip <br />�i] <br />_ T2f1811t (must pmvide a lelter of consent 6om Ihe ovmer to do v.ork in lhe space) <br />I Lic. # �7 ) (�,�� <br />"1� PhonelEmaii <br />JTACT FOR PERMIT <br />>� D t� �O� T� � <br />�ryz� <br />I <br />' 1!� .l ' <br />�S?.E_� <br />Phone/E-mail � Ov � j � �.. t✓( � <br />BUILDING PERMIT �APPLICATION CONTRACT PRICE OF WORK �000 <br />Existing Use of Building N�io'�1 HEAT SOURCE: <br />Proposed Use of Building �'" ���, , Gas Electric � <br />Building type: _ Single Family _ Duplex _Townhouse Multi-Family �Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair T.I. _ Sign _Sprinkler _Demolition Change <br />DESCRIPTION OF WORM: (additional space provided on the back) :� —�VIQ�.&.l, T, ���� � <br />{��,��"F'Pi C,� �o '�Nc�up� � t�l� tJG,V�I L1C-�V NC�; ,��,"��'� � h <br />� _ �to c�c��, -ro �si�N c� - . <br />MECHANICAL IPERMIT APPLICATION <br />of Project: _New_Addn _Alteration _Repair <br />Show Number (#J of fxtures <br />A/C — air handling units <br />Gas piping <br />Water heater <br />Gas fireptace <br />Gas range <br />Clothes dryer <br />Ranqe hood <br />Heat pump <br />Unit heater <br />Du <br />SPRINKLER / SUPPRESS <br />' Number of Heads <br />of Use <br />�5�� <br />, �F�� <br />PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn _Alteration Repair <br />Show Number (#) of fixfures � <br />Bathtub <br />Lavatory (wash basi <br />Shower <br />Kitchen sink & dispc <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mc <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 ihat I have read and examined this application and know the same to be true and correct. All provisions of iaws and ordinances goveming ihis rype of work will be complied <br />with whether specified herein or not. The granGng of a pertnit does nof presume to give authorily to violate or cancel the provision of any oiher slale or local law regulatlng consiruction <br />That I am authorized by the owner of ihis roperty to perfortn the work forwhich applica6on is made and 1 comply with ihe State Contractors Law 18.27 RCW and 296.200A WAC. <br />�� 2 zl 2�� <br />, <br />Ow r Authori ent Signa e Date (Revised 6/2012) <br />G <br />