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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 ADDRESS: PROPERTY TAX# PERMIT# <br /> � �'-► ��1�%°'�;y <br /> LEGAL for new construction: Short PlaUsubdivisionFV�'�+�d�i� ��2� Lot No. (attach copy of long legal description) <br /> OWNER��.�"�_ �,+�{, Lr�(..s �T�7+1/L'�Z� Phone/E-mail��ZS��,S 3 "`Z.p�� <br /> 1 Z-.:u S'..s rr V�C�TT V1�v'i v-- V::----\ q <br /> Address '� -4_ �� City/State/Zip �� �- 1��� <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor'S AgBfll _TBflBfll(must provide a letterof consent from the owner to dowork in the space) <br /> CONTRACTOR�� l,.,F f�L.�l�-L �lt'�LSr � State Lic.#��Z�-1�bT QI�}�X.'����5 City Bus. Lic. �O 3-Ll��i�rslo� <br /> Address -��•_� rv�:c . Phone/Email ��v1n'�, <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �-0�� ��j.t,[-� <br /> Phone/E-mail �42�� �5�-4�•o Z <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ <br /> Existing Use of Building _ HEAT SOURCE: <br /> Proposed Use of Building Gas ✓ Electric Other <br /> Building type: �ingle 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(additiona/space provided on the back): <br /> �� iCf ti���,�t L°� �=z�� t'�.�Ati� ���� -2�, -at <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(#J of fixtures Show Number(#J of fixtures <br /> f A/C-air handling units � Toilet <br /> Forced air systems � Bathtub <br /> Gas piping R{ Lavatory (wash basin) <br /> ► Water heater / � Shower <br /> 1 Gas fireplace i Kitchen sink&disposal <br /> � � � Gas range 1 j Dishwasher <br /> Clothes dryer i Clothes washer <br /> ( ; Rangehood � " <br /> � ; Exhaust fan Sink (service/bar/mop/etc.) <br /> ,r f Heat pump �- Backflow preventer <br /> i Unit heater ._ Urinal <br /> i Boiler -� ' Drinking Fountain <br /> *— Refrigeration j Floor drain <br /> -- Woodstove — I Grease trap <br /> Ducting Roof drains �vn+SP�J. <br /> Other ---� � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> •— i 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 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 aut�orjzed he ner oi this property to pertorm the work for which application is made and I comply with the State Contractors Law 18 27 RCW and 296.20DA WAC. <br /> !I J <br /> '3-��-1a <br /> Own�/�qu�horized Agent Signature Date (Revised 3/2013) <br /> �' <br />