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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 /> SITE AD E S' �� PROPERTY TAX# P R T# <br /> '�D�'� �+l�A.StNa �D �l�f" 61.�6 D 2-f�2 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long lega)description) <br /> OWNER �b���7 Phone/E-mail <br /> Address �� w� � 1�� 17�S U 6'�"�� City/State/Zip S����, �J� �r�'�{"'��,�'7 <br /> APPLICANT:�Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant�m�st Prov�ae a ieuer or�on5encrrom�ne owner�o do woric in me space> <br /> CONTRACTOR L �d State Lic.# p g MLCity Bus. Lic.#C} p � <br /> Address Phone/Email � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �� ��Y�t.�as-�..�$-o��� <br /> Phone/E-mail d(� � <br /> BUILDING PERMIT APPLICATION coNTw�cr PRice oFwoRK �•�,�794� R1 J e �o <br /> Existing Use of Building �FG HEAT SOURCE: <br /> Proposed Use of Building M F� 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(additional space provided on the back): <br /> G�au s7�/�7 a 1,1 c�r S(.�/' o�U Giz�,� ��u � 4D�-�.3 /�i��l��l�' -7� s��.u,� fdJ' �t T-a v.v,o�ll�.� <br /> �R- iDu U,v� ��1 �c/`�r��'�° R�F,�2�z�c�. P l�1�o/-- o �o ., <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 fixfures Show Number(#)of flxfures <br /> A/C—air handling units_ Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash bas.in) <br /> Water heater Shower <br /> Gas firepla� Kitchen sink&disposaF'== <br /> Gas range Dishwasher <br /> Clothes dryer � Clothes washe� <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 witl be complied <br /> with whether specified herein ar not.The granting of a permit does not presume ta give authoriiy to violate or cancel the provision of any other state or locai law regulating construction <br /> That I am authorized by the owner of this property to perform the work for which application(s made and I comply with the State,Contractors law 18.27 RCW and 296.200A WAC. � <br /> � 6� � � V�' <br /> .2 Z ,� � <br /> Owner/A oriz d gent Signatu .Date (Revised 3/2013) <br />