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• • _ <br />PERMIT APPLIC�4TION <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 />SITE <br />�DD'3 W CA,SIN�D `P.D <br />LEGAL for new construction: Short PlaUsubd <br />��- .:;+4��3, i IPROPERTYTAXq <br />r� <br /># <br />No. (attach copy of long legal description) <br />OWNER 66�t �, G Phone/E-mail <br />Address r � W� 3� �� � � S��'� " �� City/State/Zip �[.91��,.�, , �1�%A - 1 b�z�"`" Z�,Q f% <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �musc provide a ieuer ot conseni rrom ma owner io do woric in �ne space� <br />CONTRACTOR <br />s% rit (�, ��� IState Lic. # <br />Bus. Lic. # <br />Haaress Phone/Email <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />�� DC�A`f �lZ. q �5-�� �0 �� �g <br />Phone/E-mail (�� d(� � <br />BUILDING PERMIT APPLICATION cONTRACT PRICE OF WORK �� F SOL! <br />Existing Use of Building ��G HEAT SOURCE <br />Proposed Use of Building M F�7 Gas Eiectric 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 (additional space p�ovided on the back) : <br />� � � c�-r�� '� ) i r i n�� ��u-,� � �- �i� r►� �r�.. � a - s 3 l � � f 1� �a -� .�. I . <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />� Gas piping <br />i Water heater <br />� Gas fireplace <br />Gas range <br />� Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />� Woodstove <br />� Ducting <br />I Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />� Tailet <br />; Bathtub <br />� Lavatory (wash basin) <br />� Shower <br />� Kitchen sink & disposal <br />Dishwasher <br />� Clothes washer <br />� Water heater <br />Sink (service/bar/mop/etc.) <br />� Backflow preventer <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />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 specifed herein or not. The granting of a permit does not presume ta give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized 6y the owner oi 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 />G � ,. 1 Y >.� � <br />Owner/At� riz d gent Signatur Date <br />(Revised 3/2013) <br />