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• • <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, A 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />� I"y�/�' i�1,1;a � 1�l1(y /��Z . <br />ADDRESS: `-,/';f(J{j (,1/�S <br />LEGAL for new construction: Short PlaUsubdivision <br />OWNER �(,( t �Q✓�/Q✓�i ���`iQ,S <br />Address `� �o �lli�l�-S ((�(�o V ✓� �• i <br />ii, <br />ICANT: _ Owner _ Owner's Agent � Contractor <br />- s � '' <br />� <br />IT # <br />� <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail a� �p 3�9 � / �/ � � <br />CitylState/Zip S ��'�(�p� �{� � B � �' <br />Contractor�S Ag0f1t _ TBflBflt (must provide a letter of consent from the owner to do w9rk in the space) <br />✓ State Lic. # <br />Phone/Email <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />Bus. Lic. # <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building �/�C�V'��� n� �> HEA SOURCE: <br />Proposed Use of Building � o c� ���� Gas_ Electric_ other_ <br />Building type: _ Single Family _ Duplex _Townhous Multi-Family _ Commercial <br />T pe of pro'ect: _ New _ Addition _ Remodel �epair _ T.I. _ Si n_Sprinkler _Demolition aChan e of Use <br />DESCRIPTION OF WORK (additional space provrded on the back) :.6�`r" S D 4I� G f1(L�—/�� �i T��'e u� �'�' � <br />fl� �� 6L � 1� c f,� l q �� S B P� N� 6-� �i.�f�, v�. 1� a�. a'�� ��d�'� i� p�= L� �� ����S t <br />�bN�oa� �o��-- Kou, � c��FNI'�I� ��s��Q� . ���t�s`���5 T� ��� <br />� �-�� v � � �' L� � � S <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Num6er (#J of fixtures <br />� A/C — air handling units _ <br />Forced air systems <br />I Gas pipinq <br />� Water heater <br />i Gas fireplace <br />( Gas range <br />f Clothes d er <br />Ranqe hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />� Boiler <br />; Refrigeration <br />; Woodstove <br />+ Ducting <br />� <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />I � Number of Heads _ <br />of Project: _New_Addn _Alteration _Repair <br />Show Number (#J of fixfures <br />; Toilet <br />Bathtub <br />! Lavatorv (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 (inside <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />� <br />r <br />I hereby certify that I have read and examined this ap�lication and know the same to be true and correct. All provisions of laws and ordinances goveming this type of work will be comp <br />with whether specified herein or not. The granting of a permit does not presume to give authority lo violate or cancel the provision of any other state or local law regulating construction <br />That I am au orized by the owner o s property to perform the work for which application is made and I comply with lhe State Contractors Law 18.27 RCW and 296.200A WAC. <br />�,. <br />/�� � � Date (Revised 4/2015) <br />Owner/Authorized Agent Signature <br />�� <br />