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PERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.overettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 9' C) ?Alt <br />SITE ADDRESS: PROPERTY TAX <br />r� r P" - .I� <br />LEGAL for new construction: Short PlaVsu�bjdivision Lot No._ (attach copy of long legal description) <br />— 1 )C OWNER � �jl�y0-ram,., 0 'k��� h'Iti� • <br />Address "L �, �t,a �l �r� �4-� � <br />Phone/E-mail � <br />City/Stale/Zip I o 2 f.f� <br />L it/\) /\) ii 0 rZ <br />1' r� <br />CONTRACTOR C Rt}1ZTY_ rL \ G r a si"12 J(�!T/I 0:7 <br />a l! <br />L& I Lic. # L P �'T (✓ I <br />Y✓ I <br />Address C U 0 Co, <br />Ito iZ 1)K- / 'j SF�?rT-t, t,t!14 Phone/Email z�(pl C —cM 2ti <br />TENANT BUSINESS NAME <br />L V IgIl4 i L S �(�,I� L ,; i W✓ Ll�r s <br />CO TACT FOR PERMIT <br />P f?)(Lja-q Prof cc ss —5St 70 <br />BUILDING PERMITAPPLICATION <br />corlrRACTPR EDFwoRI< r7s �� <br />Existing Use of Building -j?r Ti i L HEAT SOURCE: <br />Proposed Use of Building 12Yc T1a i L _ Gas V Electric_ Other_ <br />Building type: _Single Family _ Duplex _Townhouse _ Multi -Family 1X Commercial <br />Type of project _ New _ Addition _ Remodel 4 Repa#)r-"T.L _ Sign _Sprinkler _Demolition_Change of Use <br />Description of Work (additional space provided on the back): <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION PLUM131NG PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration 2Repair <br />Show Number (#) of fixtures <br />Typo of Project: _Nrw_Addn _Alteration klfRepalr <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Toilet <br />t.i <br />Forced air systems <br />Bathtub <br />Gas piping <br />✓ <br />Lavatory (wash basin) <br />r/ <br />Water heater <br />Shower <br />- <br />Gas fireplaceZ <br />hen sink & disposal <br />�&Gasrange <br />Clothes Sher <br />Water heate <br />Sink (service/ba op/etc.) <br />Heal 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 />V <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 <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 any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perforrrl the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />J /t <br />g/1/I� 1 <br />OwnerlAuthorized Agent Signature Date (Revised 22011) l� <br />