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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEAAOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />� �3.��---���_ <br />SITE ADDRESS: PROPERTY TAX # P RMIT # <br />'���c-�� � ����z�,�� ��<<l w-� �� ��6� � 3' � ��+� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER �j�l�/�/V/_Sl� f��'TC� /'/����/G�� Phone/E-mail ,,,�5_�— %j`1c5� �:��5/ <br />Address City/State/Zip /�v y �i �� L l� L�'/�. %�> _� %� <br />APPUCANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�S A98flt _ T@Ilaflt (must provide a letter of consent from the owner lo do work in the space <br />CONTRACTOR J—i�G� � j�_ � T j-�� � ����i �� C State Lic. #�%'I u-c"c r�1. C�. Ltv� City Bus. Lic. #C��/fS� S <br />Address � fi�(� J �/ � �� .�ji �: l�C�Yf�I L L�%-� �f,�/� �%�� z�G/l� PhonelEmail :�� �-.y 3�-�> Lr�C�C:� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />L= (� c�z �% 7- C/�t E �� �Z �' L C � l�G � T/� � i-t,/�.Sh`'i <br />Phone/E-mail � j ,.� � � �� � � � :� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �'S, �%��� , c�C: <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric_ Other_ <br />Building type: _ Single Family _ Dupiex _Townhouse _ Multi-Family _ Commercial <br />Type of project� New Addition Remodel Repair T.I. Si n Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />f�G(i'�Yl���t L /dt.._ /Lc�:.,� Ci}%ZJ<i� L L�lZ�}L'�t= <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show Number (#) of fixfures <br />A/C — air handlin units Toilet <br />Forced air s stems Bathtub <br />Gas i in Lavato wash basin <br />Water heater � Shower <br />Gas fire lace Kitchen sink & dis osad <br />Gas ran e Dishwasher <br />Clothes d er Clothes washer <br />Ran e hood Water heater <br />( Exhaust fan Sink service/bar/mo /etc. <br />Heat um Backflow reventer <br />Unit heater Urinal <br />� Boiler Drinkin Fountain <br />Refri eration ),i Floor drain <br />� Woodstove Grease tra <br />Ductin Roof drains <br />Other Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM � ( Other: ;ji Ci� ,?: 5i�� � <br />Number of Heads Other: <br />I hereby ceRiry that I have read and examined this application and know the same to be true and correcL All provisions of laws and ordinances governing ihis type of work will be compl <br />with whelher specified herein or not. T granting of permit doe not presume to give authorily to violate or cancel lhe provision of any other state or local law regulating construction <br />That I am authonzed�y the ner this prope o pertorm t work forwhich application is made and I comply with the State Contraclors Law 18.27 RCW and 296200A WAC. <br />�' �-> L ��_ ��,,,, ,�z.�� � � i3 �5'- <br />Ownerl thorized ent Si ature Date (Revised 9/2014) <br />, � <br />