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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.eve�ttwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � — 3 - �Z <br /> SIT ADDRESS' PROPERTV TAX N PERMIT f �� <br /> p � �t�'� ✓�' .S� 2 � <br /> LEGAL for new cons�ruction: Short PlaVsubAivision Lot No._ (altach copy ol long legal description) <br /> II � �- � •�� � Phone/E-mail (���i ZZ <br /> OWNER Z `( ! ,; <br /> Address �4✓ /.1Z7L � CilylStatelZip � � <br /> APPLICANT: Owner Owner'sApenl .�Conlractor _ConlractofsAgent _Tenanl(m�siororaeaienaroiwnsemirommeo«nanoaowonmNespace� <br /> � �1 <br /> CONTRACTOR I �w CL��t t c� � L&I Lic.# u � OE Bus. Lic. <br /> 310 C v'f"L- �-r �iv� �✓l�'( /15V7 Phone/Email Z� � • ( S/ � 1 <br /> Address . <br /> TENANT BUSIN S NAME CONTACT FOR PERMIT '--� <br /> 2 �-I F� -�-�� v� ` � <br /> vV f � PhonelE-mail �✓ 7 [ �� + <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> �� ���� HF',iSOURCE: <br /> Existing Use of Building <br /> , � ( � <br /> Proposed Cse of Building Gsc /C- ElecMc_ other_ <br /> Building iype: _Single Family _Duplex_Townhou=_e __Multi-Family �Commercial <br /> T ne of projecl: _New _Addition _Remodel hRepair_T.I._Sign_Sprinkle/�W/"' `.'lition_Chan e of Use <br /> DESCRIPTIOI�)OF WORK(addifional space provided on fhe back):`/�/ `^ - � <br /> i i <br /> / �.` ,y !J�� � <br /> MECHAN CAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _Now_Addn _Alleratlon_Ropalr Type of ProJecL• ShowBNum6er(R)ofli tu`e5tion Repalr <br /> ShowNumber(N)ollixtures i TOilet <br /> � A/C-air handling units � <br /> � Porced air systems I Bathtub <br /> � Gas piping i Lavatory(wash 6asin) <br /> � Wa�er heater � Shower <br /> Gas fireplace I Kitchen s'nk 8 disposal <br /> Gas range I Dishwasher <br /> � Clothes dryer � Clothes washer <br /> Water heater <br /> Exhaust fan I Sink(service/bar/mop.'etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater I Urinal <br /> Boiler I Drinkin Fountain <br /> � Refrigeretion I Floor drain <br /> Woodslove <br /> � Grease trap <br /> � Duc�ing I Roo(drains <br /> Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM i Other. <br /> NumberofHeads <br /> j O�her. <br /> I hereCy ce�Ry thnt I have read and e�amined this applicetion antl know the same lo be true and cortect All pmvisions ol laws end ordinanws goveming thia lype ol work witl be complied <br /> with wheiher specifietl�erein or not.7he qranling a1 a pertn�tloes ncl presume to give authority to violate or wncel the pmvision ol any ol�er stata or laal law regulating wn.trutlion <br /> Thal I em auth�nzed by i�e mJmer ol this pmD hY�o petlortn the work lor which applicalion b maEe an71 com0ly wa�Ue State Caniractors Law 1827 RCW ana 2%2WA WF,C. <br /> /i � <br /> �', ��� ; �/�/ z <br /> Ow I,A�.horizod Agent Signaturc <br /> Dale (Revised fi�2012) <br /> � <br />