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• • <br />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 www.everettwa.org <br />ADDRESS: <br />ti2o �-ST� f' I Sw. <br />�L for new construction: Short PlaUsubdivision <br />OPERTY TAX q P�RNIIT # �� r�, <br />2sso �I � 3a o 2 do � o o � �"J 1�( � t� 1 <br />Lot No. (attach copy of long legal description) <br />'NER ( o -< < S} o v� -� {�r a r "rvK.�c �n � � Phone/E-mail YS� -��;Z - � I 7 � � <br />ress ,L}'ZL `�� Q � � h/ City/State/Zip � U,� r c-j-{ jrl�G�, <br />'LICANT: _ Owner � Owner's Agent _ Contractor _ Contractor�S Ag211► _ T2112111 (must provide a letler of consent from the owner to do work in the space) <br />CONTRACTOR <br />�� Y^! �i�' <br />State Lic. # <br />Phone/Email <br />Bus. Lic. # <br />TENANT BU51NE55 NAME CONTAGT FOR PERMIT 3 e`�� t> �— <br />f.\ C: .,.�_I i�. � ��`� ` p c4R-LGL.Cove. <br />� �� `�% �' � � �� Phone/E-mail �06 - 2y s- 06 I 3 L f�-. <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK r��,�f�.% .�-l� r <br />ExistingUseofBuilding, �¢'��'�v��t��S <br />Proposed Use of Building ���.f �w� c�^ �' S G <br />Building type: _ Single Family _ Duplex _Townhouse � Multi-Family _ Commerciai <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _ <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />HEAT SOURCE: <br />e of Use <br />RC S rD f t I-tG G C SS ��J I c PG, [ k.�v. S S� 4 C t S � t i CO M'`J�4. ✓� T ��/ I�Q O" i3O S <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />I Forced air systems <br />i Gas piping <br />i Water heater <br />Gas fireplace <br />i: Gas range <br />! Clothes dryer <br />Range hood <br />--� Exhaust fan <br />i Heat pump <br />i Unit heater <br />� Boiler <br />i Refrigeration <br />f Woodstove <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration __Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />� Lavatory (wash basin) <br />i Shower <br />; Kitchen sink & disposal <br />; Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/E;tc.) <br />I Backflow preventer <br />Urinal <br />i Drinking Fountain <br />i Floor drain <br />Roof drains <br />Medical Gas <br />Other: <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 applicalion is made and I comply with the State Contractors Law 18.27 RCW and 296.2DOA WAC. <br />� �� � <br />� �— ir ���/3 <br />ner/Authorized Agent Signature Date (Revised 3/2013) <br />