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tERMIT 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: -7-71 .i <br />PCo�+RTSAX# <br />"CY <br />PERpQj�� EfDO~60 <br />_ �� <br />L!(r ,C <br />I <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />OWNER <br />Phone/E-mail <br />Address �� <br />City/State/Zip :( <br />APPLICANT: Owner 00wner's Agent X Contractor Contractor's Agent _Tenant (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR Y r��/(%rJ'"A�' TJ l jj C% <br />L &`II Lic. # r! �'ff f, %�W Yl /e I COE Bus. Lic. # G��� 74� <br />Address �Ll` U �4� 45-7 /\ 7 44'• 4(.� Z x, � 1cro 41I civ-s- <br />Phone/Email L-�- %-757i.' Ve <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />Phone/E-mail -7%t-j(, <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />� T <br />Existing Use of Building <br />HEAT SOURCE: <br />Proposed Use of Building <br />Gas , Electric_ Other_ <br />Building type: ; Single Family Duplex _Townhouse _ <br />Multi -Family _Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair <br />T.I. Sign _Sprinkler Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) <br />: -T�,5 <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <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 property 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 />�4� \1 -7 rl,- 1; T11 1� <br />Own uthorized A t Signa ure Date (Revised 6/2012) <br />