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• <br />PERMIT APPLICATION <br />� <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 />ADDRESS:' 2�, I� � h� S UN 5 j�L��� �A PROPERTY TAX # P RMIT # <br />DO�,�-I`f0o00c�y� �I �i��<�- <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER �`}!J �}-�� D Phone/E-mail G'�� �b �;3 � Q._I�J.kl/I'pG� P�M/-}I L.�v <br />Address I Z� NIQp��p� City/State/Zip ����� wA Zo3 <br />APPLICANT:.�Owner _ Owner's Agent _ Contractor _ Contractor�S AgC'llt _ TEf1811t (must provide a letter of consent from lhe owner lo do work in the space) <br />CONTRACTOR <br />State Lic. # <br />Phone/Email <br />Citv Bus. Lic. # <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK (�T�i? �. <br />Existing Use of Building DU'P� i� HEAT SOURCE: <br />Proposed Use of Building bv��X <br />Building type: _ Single Family �, Duplex _Townhouse _ Multi-Family _ <br />Type of project: _ New _ Addition � Remodel _ Repair _ T.I. _ Sign . <br />DESCRIPTION OF WORK (additiona� space provided on the back) : <br />R�Mol»� �G� iLM�ill� .Mo1/lrl/C, S�I IUIc�S �b�l NC- <br />�iv-�Y�1� 2�Mo r/i �� GLoS �'l <br />Commercial <br />Sprinkler <br />Othe <br />lition Chanqe of Use <br />���. -��� w��u-, M o�i Fy�N(� <br />MECHANICAL PERMIT APPLICATION � PLUMBING PERMIT APPLICATION <br />Type of Project: _New �Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />i A/C — air handling units <br />Forced air systems <br />j Gas piping <br />i Water heater <br />j Gas fireplace <br />i Gas range <br />' Clothes dryer <br />B ' Rangehood <br />i Exhaust fan <br />� Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn �Alteration _Repair <br />Show Number (#) of fixtures <br />i Toilet <br />; Bathtub <br />� Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposa <br />Dishwasher <br />Clothes washer <br />Water heater <br />Backflow preventf <br />Urinal <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 type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume lo give authority lo violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the ow r 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 />6 � <br />23-��-2��3 <br />Ow r/Autho ze Agent ignature Date (Revised 3/2013) <br />