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• <br />� <br />PERMIT APPLICATION <br />BUIL.�INC/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: <br />� �'�% � <br />LEGAL for new construction: Short PIaUs <br />O W N E R��F'y}.4-CL-4z E,\[[�,t-.�G..rt <br />Address � �'''Z � ��--� Q�: G • <br />CANT <br />CONTRACTOR <br />PROPERTY TAX # <br />Lot No <br />'�n� - 0 <br />(attach copy of long legal description) <br />Phone/E-mail ,;..}�yC't"",��,'ti. f'r�r=--�--���t'";:*:f�i�"1=:� <br />Owner °�Owner's Agent _ Contractor _ Contractor's Agent <br />f'S2�!('C%�'.I�1C�r"G �6,(CSf.fAC..� !'�•t`✓-L==/�� <'.�t,ti�� <br />,v �ic Le.C.�'-'.c� �-� <=.���-rr� t� <br />BUILDING PERMIT APPLICATION <br />P <br />State Lic. # <br />T2f18f11 (must provide a letter of consent from the owner to do work in the space) <br />City BUS. �IC. # <br />IPhone/Email <br />'ONTACT FOR PERMIT -����ti.,L �j,c�-j'"�'j� <br />($Z0� j 2i:=`'� •b8�8 <br />'hone/E-mail ���ir�� {�nhar�S-�. fGiT'/ <br />;ONTRACT PRICE OF W�RK `�' '✓ ��'r OdD. � <br />Existing Use of Building �• 1- (-{c^.�',�(`C�1Cl.._- HEAT SOURCE: <br />Proposed Use of Building �•�. (--{dGl�C'C14i.r 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 />��+� ��-'C�+�=�:�=�' � t-L�G�L�CE--S a�vt ct-c�'�-- T'c�4�t�tC" c av`�..�:->`�t��.�'—Ft' a� E�Sc��tz �-4:�, <br />� � � 5�-�Ec._c.. s-��. -r� � r � � �.x-t' �a � �--� c c..t��=-s-i.� ac_r-r�'-�5r� <br />Tb � �"-,��'`c" '�fi='F�c��- . <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C - air handling units <br />I Forced air systems <br />' Gas piping <br />i Water heater <br />Gas fireplace <br />j Gas range <br />i Clothes dryer <br />Range hood <br />� Exhaust fan <br />� Heat pump <br />i Unit heater <br />Boiler <br />� Ducting <br />j Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />� Toilet <br />! Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc. <br />Backflow preventer <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />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 lype 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 pertorm the work for which application is made and I comply with the State Contractors Law 18 27 RCW and 296.200A WAC. <br />� ' / ,I � � <br />l\ ` ' L�� ��' <br />Owner/Authorize Agent Signat e:- Date (Revised 3/2013) <br />