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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 />ADDRESS: >� � PROPERTY TAX # PERM,IT/ # q� <br />1����1 ���� s��� �W ���Y� ll "'�%�� <br />1L for new construction: Short PlaUsubdivision Lot No. (attach copy of Iong legal description) <br />ER C ��p (� ( � �\'�� �{,'' � PhonelE-mail Lr_I " — ;� � <br />>s <br />��) �Ji (, � r (, �1(.�i � �vl. City/StatelZip �V� V��II { �,v� �4� LL�' <br />.ICANT: _ Owner _ Owner's Agent � Contractor _ Contractor�5 Ac]611t _ T8f18f1t (must provide a latler of consent from lhe owner to do work in the space) <br />CONTRACTOR l.�'�'��� 1"i�i � I�I�.�, <br />4ddress �Ci�,1 1��' fiY+� •1,�17 ��V�1 <br />TENANT BUSINESS NAME <br />lil 1�''����� VV�.Y� ��S�i�V 1 v i <br />BUILDING PERMIT APPLICATION <br />� <br />L-� �� � 1 1' L& I Lic. #"1 �� L �i%(�' �j�� l� � COE Bus. Lic. #(��" �' <br />�pj"���(��I�?� PhonelEmail��vr').C(,� , � �i 1'1' Y �� , ,� <br />CONTACT FOR PERMIT <br />i`�CI1' i� ►'1 � i�' r1�(� ►'1 Y�:t�-l�e�,�� C'- �,�����ti� eti� <br />PhonelE-mail � C� � <br />CONTRACT PRICE OF WORK � 1� Ll'�-'1 <br />ExistingUseofBuilding I��L�,C1�ivt$� �ii.�"�IZaI (,:IIY�ri(1 HEATSOURC : <br />Proposed Use of Building ��' 1������i�i Gas Electric �' Other_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family i�' Commercial <br />Type of project: New Addition Remodel Repair _ T.I. ;i Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back : Y� �I� �� <br />� �'_�e�^� c� � �-�-�-�i � � m� �t c�F � � c��t �e � r�n c� v� �x+�n�e�n i �� 1 �: , <br />�., �.�-+�.. �,�e �. �-ev��v�c- � ��'�cX F�e. �K � �-,�i � c1 � u��c11-� �� ��c�t,� , <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Num6er (#) of fixtures <br />.,�., — a�� � �a� � <br />Forced air sy: <br />Gas piping <br />Water heater <br />Gas firepiace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />/ SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Num6er (#) 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/barlmoK <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 [his application and know the same to be [rue and correct. All provisions of laws and ordinances goveming this lype of work will be complied <br />with whether spec�ed herein or not. T� granting of a permit does not presume to give authoriry to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner of t property to pertorm the work for which application is made and I comply with the State Contrac[ors Law 18.27 RCW and 296.200A WAC. <br />! � � ��' �� � � ��� <br />Owner/ uthorized Agent Signature Date (Revised 6/2012) <br />