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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 q PERMIT# <br /> t��3 i�-�-'GKE��(��� A�l�. ,�, c�' ;�- __Ci='� �,; <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> M�GKA6(.•raAPE�t16 c." . <br /> OWNER #��Y���"�G ��--�� c.�--'���GFS Phone/E-mail Z„ <br /> Address ��j2� GQ(�JY �.��. City/State/Zip �Y��'t-j`r' �� , �fj2�� <br /> APPUCANT:_Owner �Owner's Agent _Contractor _Contractor�5 A9BIlt _Telleflt(must provitle a letter of consent from the owner to do work in the space) <br /> CONTRACTOR �T'��.t�'I� G�FJ�(�`�If.,1�State Lic.# City Bus. Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT q��(��( G�AYL..�� <br /> -t�'-a�ct��'.c MEr�c�ct� �-�� • <br /> Phone/E-mail dGYcn��bnhar��.��� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � 2, �1�'v, O?�J. Oa <br /> Existing Use of Building �� �'�1-�' G L( ��G- HEAT SOURCE: <br /> Proposed Use of Building ��� DGG LS�/kt�iG.`Z'" G(1,�I(G Gas_ Electric_ other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family X 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 /> -fi. l. 't�-E�a't7�L -�'4Zc�s�-I�" a� -tt-�E ���G� Z�1'-a�-�b �[�`' c�� <br /> "C�-kE GXC�c�1G� `tb ac�(1��LG--�' rc�cEt�cc�t, GcrCt-L�G• <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 /> � A/C—air handling units Toilet <br /> ( Forced air systems ; Bathtub <br /> i Gas piping � Lavatory (wash basin) <br /> ! Water heater � Shower <br /> ! Gas fireplace Kitchen sink&disposal <br /> I Gas range Dishwasher <br /> � Clothes dryer ; Clothes washer <br /> � Range hood ! Water heater <br /> � Exhaust fan ; Sink(service/bar/mop/etc.) <br /> � Heat pump � Backflow preventer <br /> Unit heater I Urinal <br /> ; Boiler i Drinking Fountain <br /> � Refrigeration ! Floor drain <br /> ; Woodstove I Grease trap <br /> I Ducting � Roof drains <br /> � Other i Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM i 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 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 RC W and 296.200A WAC. � 1 <br /> � � 4� <br /> \ <br /> ' �•22 l5 � <br /> Owner/Authonzed gent Signature Date (Revised 3/2013) <br />