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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> !! )G `' �` 1 - G` <br /> I ot`l t.1►�� 2, C' C ) GLS <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER I r <br /> �,5 G V i W ��Y1�,J J�1 A(� Phone/E-mail <br /> Address 'J,j , {C t`J i Q . ( j;, City/State/Zip W I I (AeP-V, , Wk— (ft <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR--IBD L&I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINE S NAME CONTACT FOR PERMIT <br /> Phone/E-mail's t'4� �l�L "�� I ►Gd;'1=i- 1lLLta?L f�ICLtG <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building I iN►?"GiY!t l yo e L�SS 4 Cyrv-,• 6(,i Li-� J HEAT SOURCE: <br /> Proposed Use of Building 11 4Lr'd1 a/ Gas_ Electric_ Other L-" <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family il"'Commercial <br /> Type of project: _New L/Addition Remodel _Repair_T.I._Sign_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): (,�i►�� �j C>�,�_I XC,.;}G1�' �Y fr+ <br /> p YoxS 'f'L' iN l� (�� I�u-w ��r �� wr►2'.S ti12 (3) <br /> t{t'ii�t Lkni.f-7JG i���3�"1r� G^+�+zZ�t 1,vt"k— tr,v rvc'�-+o jq. <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 fixtures <br /> A/C-air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads 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 application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WRAC. <br /> Yby <br /> �G <br /> ' J / <br /> Owner/Authorized Agent Signature I Date (Revised 6/2012) <br />