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PERMIT APPLICATION <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 q PERMIT <br />,j�'/ S (-� E'i�°',�'_ ��f'M-` ��,ya,� L-�i. ' � � L��; �. _e,�,'�) <br />LEGAL for new construction: Short Plat/subdivision '— Lot No. "-' '(attach copy of long legal description) <br />OWNER ���/'Z(5 , ��"�7GC='�`� _ Phone/E-mail '�O(P � �c�! �Z�Z� <br />Atltlress � <br />APPLICANT: � <br />CONTRACTOR <br />Address <br />TENANT BUSI� <br />���ye � <br />�� �'� �>� <br />_ Owner's Agent _ Contractor _ Contractor�S AgOflf _ T8112f11 (mus� provide a leiter of consent from the owner to do work in ihe space) <br />i�l 1� ti-E'_ l�Z_ + State Lic. # ��' ( �`� Citv Bus. Lic. # <br />BUILDING PERMIT APPLICATIOfV <br />�Phone/Email <br />CONTACT FOR PERMIT <br />Phone/E-mail � V "' <br />CONTRACT PRICE OF WORK <br />Z�'�_'�Zz! <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building �� Gas_ Electric_ Other_ <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 (additional spac provided on the back) : � l <br />/ � / <br />��?: -}.} � � �' �� `'l [9�>.s �.� ;. � ��;�L�.(,i �F�(Z �;� . <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />I Forced air systems <br />j Gas piping <br />� Water heater <br />Gas fireplace <br />� Gas range <br />Clothes dryer <br />Range hood <br />I Exhaustfan <br />Unit heater <br />Boiler <br />� Ketrigeration <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 (#J of fixtures <br />� Toilet <br />� Bathtub <br />� Lavatory (wash basin) <br />j Shower <br />i Kitchen sink & disposal <br />j Dishwasher <br />� Clothes washer <br />i Water heater <br />q � Sink (service/bar/mop/etc.) <br />' I Backflow preventer <br />i Urinal <br />Drinking Fountain <br />j Floor drain <br />; Grease trap <br />� Roof drains <br />� Medical Gas <br />i Other: <br />i Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correcL 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 n <br />That I am authorized by the ownerp is prop2rty ��rform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. �/l <br />/ �. ��. <br />% � / f,� d _.a.�.� <br />� � / � Z/ �ZC�• (� -/ <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />�. <br />