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' "-`"'% �� I : <br />�ERMIT APPLIC ' �- `�� =l� � <br />f � � �� <br />BUILDING/MECHANICAL/PLUMBING/SI /S�9fI�1�C��R/ MOLITION <br />CITY OF EVERETT PERMIT' ES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 4���8�'l� everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� <br />SITE ADDRESS: PROPERTY TAX # PERMIT # <br />i'� i� Pnr�_ 1�,r .^ E�v��� \�� A- G SC2�� [f's�U�l (1'f� c�c���t �� <br />LEGAL for new construction: Short Plat/subdivi <br />OWNER � <br />Address t <br />CANT: Owner <br />�dress � �� S ��( <br />ENANT BUSINESS NAM <br />No. <br />Phone/E-mail <br />City/State/Zip � <br />(attach copy of long legal description) <br />f VV�.� <br />Owner's Agent � Contractor _ Contractor�S AgOflt _ T8fl8flt (must provide a letter of consent from the owner to do work in the space) <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building <br />L& I Lic. #l� �[�,� � COE Bus. Lic. # <br />�` �"3�� FnonelEmail C�) � ��'�, " � � � <br />CONTACT FOR PERMIT <br />C'1Y�1�1.:•:;C(:G��1�.i�1-jl'l(� �� <br />Phone/E-mail ( �� j,�1�� "��� <br />CONTRACT PRICE OF WORK C��(�� <br />HEAT SOURCE: <br />Proposed Use of Building � Gas� Electric Other <br />. <br />Building type: �'�Single 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 (additiona/ space provided on the back) : <br />���ka.�� G�uS ���G�t.� . t�rr�n � (..�=tl� � � v��� �►'� . � S k- � i U <br />MECHANICAL PERMIT APPLICATION <br />of Project: �New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />' Water heater <br />Gas'�rep!ace <br />s Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />; Other <br />SPRINKLER / SUPPRESSION SYSTEM <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 />K.itchen sink & dispesaf <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease tra <br />Roof drains <br />Medical Gas <br />Other: <br />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 law regulating construction <br />That I am authorized by the owner of this pro erty to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />r---------- j <br />� . ' 1 �Z <br />� <br />Owner Authorized Agent Signature Date (Revised 6/2012) <br />