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ERMIT APPLICATIO <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 />sirl � Z�ss: IO2 � ��`" �(t% �v2 <br />LEGAL for new construction: Short PlaVsubdivision <br />OWNER <br />APPLICANT: <br />ERTY TAX # <br />P <br />/ <br />No. (attach copy of long legal description) <br />" ���C�� Phone/E-mail Z�(y 9`9 Z.3 U <br />� 5�f S f L� City/State/Zip � Z v <br />Owner _ Owner's Agent _ Contractor _ Contractor�S A92111 _ TEIl8f1Y (must provide a letter of consent from lhe owner to do work in the space) <br />CONTRACTOR <br />TENANT BUSINESS NAME <br />��� c��1v� <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building 7�e�'G!� � <br />Proposed Use of Building �� <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _ <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />►�vt- p t7 ��t�D t l�(.iGl�-GY" `��4 iv �� 1� � 2 Yi�t-�7U 2_. <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />� Water heater <br />j Gas fireplace <br />� Gas range <br />� Clothes dryer <br />Range hood <br />( Exhaust fan <br />Heat pump <br />I Unit heater <br />Boiler <br />� Refrigeration <br />� Woodstove <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />Bus. Lic. # <br />HEAT SOURCE: <br />Gas E <br />nmercial <br />Sprinkler _Demolition_Change of Use <br />t�`�,c� P/1'` <br />PLUMBING PERMIT_APPLICATION <br />Type of Project: _New _Addn ✓ Alteration _Repair <br />Show Number (#) of fixtures <br />; Toilet <br />� Bathtub <br />Lavatory (wash basin) <br />�;,i° � Shower <br />� Kitchen sink & disposal <br />� Dishwasher <br />, � Clothes washer <br />�'� j Water heater <br />j Sink (service/bar/mop/etc.) <br />� Backflow preventer <br />I Urinal <br />i Drinking Fountain <br />� Floor drain <br />� Grease trap <br />I Roof drains <br />� Medical Gas <br />I <br />j Other: <br />! Other: <br />I hereby certify lhal I have read and examined this application and know the same lo be true and correct. All provisions of laws and ordinances governing this type of work will be complied <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 l� 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 />� � <br />��1 % �--• �y <br />� � !V � ��` L � � <br />Owner/Authorized Agent Signatu / Date (Revised 3/2013) <br />