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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO d PM --oq "1 <br />tJ <br />SITE ADDRESS: PROPERTY TAX # PER IT# <br />— <br />l-t Vn1 W; E<V- i i 1,1414- I , ,4 <br />LEGAL for new construction: Short PlaOsuub�bdivision Lot No._ (attach copy of long legal description) <br />OWNER 'f1-'C 'k-� ��'� <br />PhonelE.mail <br />GI�IY�li-h: <br />('] <br />City/Slalelzip (a',VTL!')'/j0J o1z �z C' Lf <br />Address 2l Jb�i T--,,FT-tt JN'L/rz-- <br />CONTRACTOR C,1-WA-.)?Try V2 CUvT`.:Tf2�LrIC�7 <br />��"�tl <br />L&ILic.# L.1Aj4-1� C, 1l I Pvl <br />Address () v r 6'Ft� 2 FlK z>r SI.,iT-L r,- LIJ P, Phone/Email ( ZO(p C I - <br />TENANT BUSINESS NAME <br />CO TACT FOR PERMIT <br />nj214YJ fla(Cc <br />L-V tl)i41 LS Y✓.I) L,,i lJ✓ L14/IS <br />P <br />r <br />BUILDING PERMIT APPLICATION <br />CONTRACT PR E OF WORK d �S /� <br />Existing Use of Building -17K Tia-1 i_ <br />HEAT SOURCE: <br />Proposed Use of Building V2r- fl9-i L Gas Electric_ Other_ <br />Building type: Family _ Duplex _Townhouse —Multi-Family Y Commercial <br />_Single <br />Type of project: _New _ Addition _ Remodel Repai "1. _. 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 <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Now_Addn _Alteration I�Repalr <br />Typo of Project: _New_Addn _Alteration�Repair <br />Show Number t #) of fixtures <br />Show Number (#) of fixtures <br />j I <br />A/C - air handling units <br />Toilet <br />V <br />Forced air systems <br />i/ I\ <br />Bathtub <br />Lavatory (wash basin) <br />Gas piping <br />Water healer <br />I <br />\Shower <br />Gas fireplace <br />hen sink & disposal <br />range <br />Dish sher <br />aaGasrange <br />tdryer <br />ClothesZFountaln <br />Ran ood <br />✓ <br />I Water h <br />Exhaust <br />Sink (sea op/etc.) <br />Heat pump <br />I BackBo,nter <br />Unit heater <br />Urinal <br />Boiler <br />Drinking <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 />I 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 perform the work for which application Is made and I comply with the Stale Contractors Law 18.27 RCW and 296.200 WAC <br />` $/� //►/ (Revised 2/2011) <br />Owner/Authorized Agent Signature Date <br />e� <br />