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� <br />� <br />PERMIT' APPLICAT'ION <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 />SITE ADDRESS: PROPERTY TAX i# PERMI�i'� ✓ D� <br />oz — �.�- <br />, <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER G � '— jZ. Phone/E-mail <br />Address 3 j � �p� S "r� City/State/Zip � ��- �j �Q <br />APPLICANT: _ Owner � Owner's Agent _ Contractor _ Contractor�S AgBftt _ TBI18�1 (must provide a letter of consent from the owner lo do work in the space) <br />CONTRACTOR — V �' 1,' � }'� -i— . state �ic. # (�-C. ���-E � y Bus. Lic. # <br />Address �� , I � � Phone/Email <br />TENANT B SINESS NAME CONTACT FOR PERMIT <br />G�{�-L S 1.�K l�. 425 •.757 • 88 �7 <br />�}�� �i �`�j�{Z Phone/E-mail lr� e Gy'G Gc.. D� <br />BUILDIMG PERMI�T APPLICA`TIOI�1 CONTRACT PRICE OF WORK QXi <br />Existing Use of Building ��L� u�7�rr�I HEAT SOURCE: <br />Proposed Use of Building ����i �---�7��-� Gas %� Electric Other <br />Building type: _ Sing!e 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 />�1�W 11U L-� ��'�r'-�-y!'-�, — � ��,:���--��C,t� ���Y'— � <br />�����.-La��.� �X l =�i7�1,`�- 'vV�%'-�� ��`v'`, � �"�.-x.��> ��� t= <br />r C���: �'A�j � �. -_'r. �. � � - <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show Number (#J of fixtures <br />A/C — air handling units � Toilet <br />I Forced air systems � Bathtub <br />j Gas piping � Lavatory (wash basin) <br />� Water heater j Shower <br />Gas fireplace j Kitchen sink & disposal <br />� Gas range i Dishwasher <br />Clothes dryer j Clothes washer <br />Range hood ; Water heater <br />� Exhaust fan � Sink (service/bar/mop/etc.) <br />� Heat pump I Backflow preventer <br />i Unit heater i Urinal <br />; Boiler Drinking Fountain <br />� Refrigeration j Floor drain <br />Woodstove i Grease trap <br />Ducting � Roof drains <br />� Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads i Other: <br />I hereby certify that I have read and examined this application and know the same to 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 taw regulating construction �� <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Coniractors Law 18 27 RCW and 296200A WAC. � <br />G .� - s � �o� <br />Owner/Authorized Agent Signature Date <br />(Revised 3/2013) <br />