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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 wvnv.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: <br />PROPERTY TAX It <br />P.C�-ihliTzp_ <br />,�-r G <br />LEGAL for new construction: Shod Plat/subdivision <br />_Lot No._ (attach copy of long legal description) <br />OWNER �y l,lA,.! .ti41t;7•.�Y (nlil./k <br />Phone/E-mail ?ln,- <br />Address <br />City/Slate/Zip cll <br />w <br />r <br />APPLICANT: Owner U:rner's Agent _Contractor Contractor's Agent _Tenant (must pvvlds a letterofsomerdasm the owner to dowerk in Ne space) <br />CONTRACTOR (Litt " <br />L & I Lic. # r-. � :C'-4 GJz�'�( COE Bus. Lic. # <br />Address FJ Me,I D',L1,v'(-1 <br />Phone1Email/cjZfl?6O-Ci Q <br />� <br />TENANT BUSINESS NAME <br />I!' <br />C) Iin(. vn'k <br />CONTACT FOR PERMIT <br />PhonelE-mail ) (91 r (-� ;7-j i ' i, t•%, ..'n <br />CONTRACT PRICE OF WORK <br />_ <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building <br />Proposed Use of Building <br />Building type: _ Single Family _ Duplex _Townhouse _ <br />Type of project: _-New _ Addition _ Remodel _ Repair <br />HEAT SOURCE: <br />Gas_ Electric_ Other_ <br />Mulli-Family _ Commercial <br />_ T.I. _ Sign _Sprinkler _Demolition_ Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />E <br />, I <br />�I <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION .I <br />Type of Project: _New_Addn _.Alteration __Repair <br />Show Numberill) of fixtures <br />Type of Project: _New_Addn _Alteration_Repair <br />Show Number(h) of fixfures <br />AI0 - 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 />Cloches dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (servicelbar)mopletc.) <br />Heat pump <br />Backilow, preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodslove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER <br />I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby wary that 1 have read and examined this application and know the same to be We and correct. Ag provisions of laws and ordinances governing this type of work wall be complied <br />with whether specified herein or not. The granting of a peril does not presume to give authority to violate or cancel No provlslon of any other state or local law regulating construction <br />That I am authorized by the or)her of this property to perform the work for which application Is made and I comply win the Slate Contractors Law 18.27 RC W and 299.2DOA WAC. <br />Owner/Authorized Agent Signature \ z Dale <br />(Revised 512012) <br />