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� <br />� <br />PERiVIIT APPLICATION <br />BUILDING/MECHAIVICALIPLUMBING/SIGNISPRINKLER/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 />EGAL for new construction: Short PlaUsubdivision <br />ROPERTY TAX #t <br />No._ <br />OWNER� �' �7�" ��US/J� Gi j�C.�/ �� PhonelE-m I <br />�..� :� <br />Address � �� � �j �j`L��'{ City/Siate/Zip <br />APPLICANT: _ Owner _ Owner's Agent Contracior _ Contractor's Agent _ <br />CONTRACTOR j���� � /`7"% �}iC. ✓ C��� 1�LIL( i�'�� State Lic #, <br />Add-ess �G� }1C'`/l �--' / J � <br />TENANT BUSINESS NAME <br />�=�°,'x='ffI ,�y�c��iu <br />BUILDIN� PERMIT A�' <br />�"�f�G� ��'� <br />PLICATION � <br />ONT <br />PERMIT # <br />_(attach copy of long legal description) <br />' � ) ����' l L,-��1' <br />`fA'_flf": C1,r1`. `'��•�F <br />- ��7� <br />TEflB�t (m�sl provide a leiter of consent (rom the owner to do work in the space) <br />J, �i C x 5�� ��/ /�� City Bus. Lic. # , <br />Phone/Email <br />f% ' <br />ione/E-mail �%��t � . �/��� /1,G7��`_` <br />ONTRACT PRICE OF WORK � <br />Existing Use of Building _ H T SOURCE: <br />Proposed Use of euilding Gas Electric Other_ <br />Building type: __ Sinyle Family __ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkle _Demolition_Chang2 of Use _� <br />Q.�SCRIPTION OF WORK (additional space provided on the back): � , v ��;� <br />, <br />( _ �/�)�l �� /����'..' J-c�� �_ 4 . <br />, <br />,(�, Y ,,�r �" V-'"i � iL i � � ��l N� �—i,� � /J. 3 � `� � � ��'7 �� Y� t �C..� �� ;, l�`.i `t _ ' ! c c� c <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn 4Alteration _ <br />5how Number (#�f fixtures <br />j A/C — air handling units <br />I Forced air systems <br />' Gas pipin� <br />� Water heater <br />j Gas fiieplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />j Exhaust fan <br />j Heat pump <br />��� ; Unit heater _�,� j',J <br />� Boiler <br />Repair <br />' Refrigeration <br />; Woodstove <br />Ducting <br />� pther <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (s�) of fixtures <br />Toilet <br />' Bathtub <br />j Lavatory (wash basin) JJ <br />j Shower <br />Kitchen sink & disposal <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 trap <br />Roof drains <br />j Medical Gas <br />Other <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be lrue and correcL All provisions of iaws and ordinances governing ihis type of work witl be complied <br />wnh whether specdi herem or not. The granting of a/�permit does not presume to give authoety to violale or cancel the provision of any other state or local Iaw regulating construction <br />Thai I am auth + ed by the owner of this prope�ly Iq�¢erform the work for which applicalion is made and I comply with the State Contradors La�v 18 27 RCW and 296 200A WAC <br />/ <br />� ' �/ ,� /�------ � `. � 7-_ <br />: . ,��/y <br />OwnerlAuthorized Agent,.Si"gnature Da (Revised 3/2013) <br />