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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: `�4ry �� Dh _� ,�.� PROPERTY TA�X���/ i����> �i11pjT# W� <br /> I �`1 •z�, ..�t� 2 �1 <br /> LEGAL for new construction: Short PlaVsubdivision � � i �� rC l� Lot No.� (attach copy of long legal description) <br /> 1�,, � m�t�zj►�ct. V�°►n.' ;��C r"��� ,c� C�.�►;�V��. c� �r� <br /> OWNER /�� ;�,�� ��,1Z.-�►`�.d.��'� Phone/E-mail 25; �1--� ! � — 5 <br /> Address 1� 1�_S �c�,n L� �� � � � City/State/Zip �L( G1(.(L! > �Fl �(�_�/�3 <br /> CONTRACTOR y'1 l,1 IU�� (,L) L& I Lic.# C�[.r-/L�/1/�/Z,�L ��:� �� <br /> � i � t'►"1�tL�� � �i1 L.l-1�C-' �. '/�. E? <br /> Address ��� �C�,�a'� �'c.C�'��Sf� �;, ci(1.� �'t�"�7� Phone/Email ,2�3 ��1�� ` �:>� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT '��,`UK� �E;�1� Sf'l �ftl�,� <br /> /�/r� i"V1/-ik.�.)l�t. Vtt/L,� G ` L- �� ���V/L'� CL'r•� <br /> Phone/E-mail ,�S�j �c ;J ' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building /�/� HEAT SOURCE: <br /> Proposed Use of Building �"�; Ji`Y'� �f • "���''e�,e 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 space provided on the bCar: ��� <br /> u 11S(����,�,C�C�,PI � �.t /lf'u-�> �t- �'�i C�d1111G"'� � �'��r G � <br /> e� <br /> /1 <br /> � <br /> Have you started working without a permit? _YES �NO `���"���'��'� � <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(#)of fixtures <br /> A/C—air handling units Toilet <br /> � Forced air systems Z Bathtub <br /> [.� Gas piping Lavatory(wash basin) <br /> � Water heater Shower <br /> � Gas fireplace Kitchen sink&disposal <br /> � Gas range Dishwasher <br /> r" Clothes dryer Clothes washer <br /> Range hood ` er heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater 7 Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Q Floor drain <br /> Woodstove Grease trap <br /> j Ducting VS Roof drains <br /> Other Medical Gas <br /> S RINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads 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 <br /> this type of work will be complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of an other state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to perfor th w i lication is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> `y �!�� /l� <br /> Own r/Au�horiz Date (Revised 2/2011) <br /> / <br /> � <br />