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� • <br />P�R�V11T AP�LICAI"00� <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 />ADDRESS: � " ,,�/ <br />�.00D �sU�r� �� j�(Jt�. <br />LEGAL for new construction: Short PlaUsubd <br />OWNER �1 '"V���� EVI� <br />��e5s (�� C <br />PLICANT: <br />CONTRACTOR <br />Address S�'b <br />TENANT BUSIN <br />�nIJ ���53t�C% <br />Owner _ Owner's Agent _ Contractor <br />n�cc,a��c. �N Go�t <br />� <br />h/• Lt.t�-S�'#!.� �1zb, r4l, <br />PROPERTY TAX # <br />Lot Na_ <br />f► Phone/E-mail <br />1 <br />City/State/Zip . <br /># <br />(attach copy of long legal description) <br />�� <br />COl1tf8CfOf�S Ag2f1t _ T2f12f1i (musl provide a letter of consenl from Ihe owner lo do work in the space) <br />� State Lic. # City Bus. Lic. # a¢'?o�' <br />�(�'�f �,(�„ Phone/Email �IJ �" �3.� a 6 �'d <br />CONTACT FOR PERMIT <br />C,�t i`,� 1��/ e L� Es2.�'Ciy n�t� � Ca�.F-t� � i-��O/V <br />Phone/E-mail 3�i+�% "' S� '� o�s � <br />BUILDING PERMIT APPLICATIOIvI CONTRACT PRICE OF WORK G�� <br />Existing Use of Building ,i� HEAT SOURCE: <br />Proposed Use of Building � Gas_ Electric_ Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi- amily _ Commercial <br />Type of projecL _ New _ Addilion _ Remodel = Repair�T.L =Sign _=Sprinkier__Demolition Change of Use <br />DESCRIPI ION UF U110RK (additional space p�ovided on the back): <br />11�OU� �✓A1 �;'t�.cNG � �4�R-�'°t �orV S <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixiures <br />A1C — air handling units <br />� Forced air systems <br />� Gas piping <br />� Water heater <br />� Gas fireplace <br />� Gas range <br />� Clothes dryer <br />� Rangehood <br />Exhaust fan <br />Heat pump <br />� Unit heater <br />I Boiler <br />� Woodstove <br />� Ducting <br />I Other <br />SPRINKLER / SUPPR�S516F1 �l(�i�ilfi <br />� Number of Heads <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 />� Shower <br />� Kitchen sink & disposal <br />� Dishwasher <br />� Clothes washer <br />� Water heater <br />� Sink (service/bar/mop/etc.) <br />� Backfiow preventer <br />� Urinal <br />j Drinking Fountain <br />� Floor drain <br />Grease trap <br />� Roof drains <br />I Medical Gas <br />I Other: <br />� Other: <br />I nereby certify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and ordinances governing Ihis 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 violaie or cancel �he provision of any other state or local law regulating construction <br />That I am authorized by (he owner of this property to perform lhe work for which application is made and I comply with the Sfate Contracrors Law 1827 RCW and 296200A WAC. <br />�' - %;z -_ ; ,'� <br />Owner/Authorized Agent Signature Dale <br />!�L <br />(Revised 3/2013) <br />