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• • <br /> 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 /> SITE ADDRESS: �� ' ��;,���}Q�,�r� PROPERTYTAX# � � ,� P MIT# � � <br /> -�-1 s r _s'�7— �� i E,v 5��,.� ,, �� �C�.5 G�OU L UC)�, � 1� ' S(�� - "C�c..) <br /> LEGAL for new construction: ShoR PlaUsubdivision ;.+�t�:' a,��c� � Lot No. (attach copy of long legal description) <br /> OWNER � ,T t C:� l� V�_��?. Phone/E-mail Z5�ZS7'e��,� 7 �Oc>��Ct,iZ��i.t�4. C�� <br /> �j � r <br /> Address 3? E;�i C_��K��, j''� i City/State/Zip �U i'1�� - �/�� ��l� � <br /> APP!_ICANT:_Owner �Owner's Agent _Contractor _Contractor's Agent _Tenant(musc provide a iet�er or consent rrom ine owner�o do work in ir,e space� <br /> CONTRACTOR � � State Lic.# �a�}�. � L�✓{, �,_�, �x�� -'"�ity Bus. Lic. #Z - <br /> Address �� r,-'�,,., .�, � �.;��� Phone/Email <br /> TENANT BUSINESS NAM� CONTACT FOR PERMIT �Z�'� �?� rr,�rL,�� <br /> � , d Q <br /> � � ��� ��� <br /> Phone/E-mail '�C�d>�� C�''�•���J�Z� r=' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ; � �r1 � � � <br /> , <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of BuildingJr`���'�� ,c��� ��t�'ic'�'� Lo�T�"c' f7c,'Qri� Gas Electri Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family C�Commercial <br /> Type of project: New Addition Remodel Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> p��:���f��r@�R a�f�� �k= �t'�!�r�:(additional space provided on he hack): i� <br /> �..//=T -S� '�r���'✓ `-�'3 — �t��11-�'t�lJt�l �� ���C1'1'�'Y�� (��'�l/1 �t �'{" S��l�'�[v1-��-- #��J' <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 /> i A/C—air handling units Toilet <br /> ; Forced air systems ; Bathtub <br /> Gas piping i 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 /> j Heat pump Backflow preventer <br /> Unit heater � Urinal <br /> ' Boiler Drinking Fountain <br /> Refrigeration ! Floor drain <br /> Woodstove I Grease trap <br /> Ducting Roof drains <br /> i Other ' Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM ; Other: <br /> � Number of Heads ! Other: <br /> I hereby ceRify 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 a�dhorized by the owner of this propeRy to perform the work forwhich application is made and I comply with the State Conlractors Law 1827 RCW and 296.200A WAC. <br /> � <br /> /;� i �f <br /> „/�-�- r� / ��� ;��'" � <br /> OwnerlAuthorized Agent Signature • Date (Revised 3/2013) <br />