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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 /> �� ; g� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRES,S: PROPERnr rnx a P MIT# <br /> SE �Vt.r-�.�" �i ,i ,r <br /> �!!-�� Mall (,JA ' - <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER �>1�G''�l� D�I1�'V��l�"ilLt�l �/'�$ Phone/E-mail q4q- l023`77� ?�L �,� <br /> Address {g I DD r �U Sf� CitylState/Zip ri-uvU'� � q2lol2 C� <br /> CONTRACTOR 7BD L&I Lic.# <br /> Address PhonelEmail <br /> TENANT BU�INESS NAME CONTACT FOR PERMIT 5-�E {�.ALE <br /> �e �,tVG �f�/"(��1 ��'T�l�r�'i1✓L� Phone/E-mail ']07-�2�- (p7� S�G��/CO►') Olp�•('DW) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building N�Q HEAT SOURCE: <br /> Proposed Use of Building FOM�►t� ryhl�, �S�-Li,;,r'p�� Gas Electric_ Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work fadditional space provided on the back): � ' S`-� ��, <br /> C�s�uc�«� �4' a n�,� -�e�.�U1;� r�¢s�awa�+ bu�►div� analaJaoc�rt <br /> Have you started working without a permit? _YES�NO <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 handlin units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Range 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 /> 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 <br /> this type of work will be complied with whether specrfied 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 State Contractors Law 18.27 RCW and 296.200 WAC <br /> �� � 4����� <br /> Owner/Authorized Agent Signature �Date (Revised 2/2011) <br /> • • , � � . <� 1 <br /> , .� <br />