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PERMIT �PP����`TIO� <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 />v � ���A- � /� i�16i�,% ���1-�- -Sf.'�-�i� ...� � <br />SITE ADDRESS: PROPERTY TAX q P�RMIT #, <br />Zd �12.�� S - S� �,��� -�''o5"/yd��n � � ''�J� <br />LEGAL for new construction: Short PlaUsubdivision �Q ����t'¢ ���� Lot N�T / (attach copy of long legal description) <br />��- <br />OWNER �, /�i2L."'Ji� �'�"F Phone/E-mail Z �� - 2 �P / — Z �-�f � <br />Address � � f�� � �{f,� City/State/Zip ��n��� � � �;,l.� ; �o��j <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�5 Ag@I1t _ T@I10fli (mus� provide a letter of consent from lhe owner to do work in the space) <br />CONTRACTOR %Zi��q�c-Q L-• CC%�f��✓� «� State Lic. #� C/��iy'��Z �!�i`l�� City Bus. Lic. # 5`5�3� <br />Address � �r� �,� 2-�1 %� �(/�.fZQ°� �vry�--� Phone/Email yz`� ��`jy —5's� �S <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />�?,�v��d�� 5�zs =z�y--s—�7s <br />� " Phone/E-mail � �/cLck� ct� �`c�i�c.3Sf • /«%� <br />.,.� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK s�d�^d <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building ��� ���,��-� Gas Electric� Other <br />Building type: _ Single Family i> 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 bac!<) : ^ /� <br />��� = �Z�o /�r" G� �?�G u�t c�(,�sa,�'� s���� �c� /''��-n. ce A-�L �,�!'n,-,� ���__c�S. <br />%� j �'s�,� �;�;,csQ jrV��%/��-2 i/✓ �o i��,�/��-�.a !y7�%J� .E' ��j�'� �'`��`l��, <br />L-�.7�'� ���j� ��-z�sz-���1 �c , fh�� <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 fixtures <br />A/C - air handling units ! Toilet <br />� Forced air systems i Bathtub <br />I Gas piping � Lavatory (wash basin) <br />� Water heater � Shower <br />i Gas fireplace ! Kitchen sink & disposal <br />� Gas range i Dishwasher <br />! Clothes dryer ; Clothes washer <br />� Range hood i Water heater <br />( Exhaust fan Sink (service/bar/mop/etc.) <br />Heat pump � Backflow preventer <br />� Unit heater I Urinal <br />; Boiler j Drinking Fountain <br />i Refrigeration I Floor drain <br />� Woodstove Grease trap <br />I Ducting � Roof drains <br />� Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM J j Other: �'�s �L - <br />� Number of Heads i � Other: Z.-, -rt' �, - <br />I hereby certify that I have read and examined ihis 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 ihe owner of this property to perform the work for which application is made and I comply wilh the State Contractors Law 18.27 RCW and 296.200A WAC. �( <br />�--�' I Z <br />� "� I <br />� / �_ - ---- � � -- /� <br />Qw er/Authorized ent Signature Date (Revised 3/2013) <br />