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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Ever.,tt, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />A ooi ICATIONS ARE ACCFPTFD FROM 8 AM TO 4 PM ( h.50 0-7-617i <br />SITE ADDRESS:yr <br />PROPERTY TA%# <br />'ER IT# - <br />LEGAL for new construction: Short Plat/subdivision Lol No._ (attach copy of long legal description) <br />OWNER ZIJ)q S 4A)&- & r ,4jZ d 1 -� <br />Phone/Email <br />V, 2,39 <br />City/Slate/ZiP <br />Address , X <br />APPLICANT: —Owner _Owners Agent _Contractor Contractor's Agent �aTenanl(mvsiptomeabaerormnsenummmea WdownbntOsPx) <br />CONTRACTOR r- diAM t %ZV{c— <br />L & I Lic. # S0A)aS ITS Bus. Lic. # <br />GCOE <br />'re- <br />Address S6 y Yy .s/ ,y Phone/Email <br />4,L <br />TENANT/BUSINE`SS <br />CONTACT FOR PERMIT <br />rr,Z5 hq- <br />y2r�W�r_gyy� <br />�. <br />Phone/E-mall <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric_ Other_ <br />Building type: _Single Family _ Duplex _Townhouse _Multi -Family 4-Commercial <br />Type of project: _ New _ Addition Remodel —Rep ir T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />x-Germ 5e- GtJo McHIS ACgS <br />.7'.rJ <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typeof Project: _New_Addn _Alteration _Repair <br />Type of Project: _New_Addn -Alteration __Repair <br />Show Number (#) or fixtures <br />Show Number (#) of fixtures <br />A/C- air handling units <br />„( <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 prevenler <br />Unit healer <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 Dial I have road and oxemthed this application and know the same to be true and conect. All provisions of lava and ordinances governing this type of wade wl be cempied <br />with whether specified herein or not. The ranWg of a pennitdoos not presume to give authomy to violate or cancel the provision of any other stale or local lawregumlhg construcgon <br />That I am ou d the owner s prop to Porto awork for which application Is made and t comply with the Stale Contractors Law 18.27 RC W and 296.200A WAC. <br />-13 <br />Owner/Authorize Agonl Signature Date (Revised 612012) <br />