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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: <br />PROPERTY TAX # <br />R1 ^�I,T <br />1 <br />VV IJ 3 _ <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />OWNER <br />Phone/E-mail(3f ))..�tiE•%1 <br />� 1.�i9 ►, �C 'L ICE <br />Address �C�E: Lr? �V�—� <br />City/State/Zip <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 ()�kjjle_E <br />L & I Lic. # COE Bus. Lic. # <br />Address <br />Phone/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK acry <br />Existing Use of Building , �Jt°✓-���JC HEAT SOURCE: <br />Proposed Use of Building S,c�,fTCa b61pL6)( Gas Electric Other <br />Building type: _Single Family _Duplex _Townhouse Multi -Family _ Commercial <br />Type of project: _ New Addition Remodel /Repair _ <br />T.I. _Sign _Sprinkler _Demolition_ Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn ZAIteration _Repair <br />Type of Project: _New _Addn Alteration _Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />/' Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />k"&- <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 WAC. <br />�(Z <br />-.� I ,mac, - C�1 f°r;� �� I r l' /%` <br />Owner/Authorized Agent Signature Date (Revised 612012) <br />