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� <br />� <br />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 />RE:iS: <br />PROPERTY TAX # <br />IT # ,_ <br />��,4�-- �C� <br />LEGAL for nevd construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER L� T �% ��,�� nt' J-1 1�S (�t�' Phone/E-mail ��r� � 133 /`" �'� �� <br />3 �� 1 <br />CitylState/Zip `L (�•C J� � <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor �COf1tf2CY0('S AgBflt _ T2f18f1t (must provide a letter of consent from the owner to do work in the space) <br />�. � <br />CONTRACTC�R � � � c` �J � S -� �'�-v.r��� State Lic. # Q � � �� � City Bus. Lic. # i�i� � i'� <br />v� �c � k� <br />�+n k� Z -�' I—cc� •f` �-! � � � � <br />BUILDINI3 PERMIT APPLICATION <br />� <br />Phone/Email QFj � "' t/ 3L1C/ .-_L <br />ONTACT FOR PERMIT <br />;�.�k � 4`�c1� -c i�— `I � s— 7 8 c� '' J 3 7 S� ''� SA- <br />�one/E-mail ,M Q ,'�c`�y�� i � �'- Lt �,� „ 1/I {!�' <br />ONTRACT PRICE OF WORK �' t, �' r,.'�.- ___ <br />Existing Use c�f Building ��, •.� `�.-� (.��- �•� 5� � <br />Proposed Use of Building '`� G` ���'� <br />Building type: _ Single Family _ Duplex _Townhous Multi-Family ;� Commercial <br />� <br />Type of projec:t: New Addition Remode _ Repair _ T.I. Sign\' Sprinkler <br />DESCRIPTI��N OF WORK (additional space provided on the back) : <br />� r'`�G��i � d� �� iC- rt �� 5'�1 }--�-U 1,�c� f�G -� f--i-t .f i cJ' <br />'`� "( � ( Q l� P � �i \ "�cX O GL/ � , <br />HEAT SOURCE: <br />Other <br />� - � . <br />`�-r v�t;�c- S� 1 c c e � �'- �.v�ti I I ►v���� c�,� `� �� S��`� 1= c���w�1 <br />MECIHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtuies <br />A/C - air handling units <br />Forced air systems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Ketri eration <br />Woodstove <br />�- Ducting <br />� Other <br />SPRIINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />Toilet <br />Bathtub <br />Lavatorv (wash basin) <br />Shower <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/i <br />Backflow prevente <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Roof drains <br />Medical Gas <br />Other: <br />I hereby certiry th�it I have read and examined this application and know the same lo be true and correcl. All provisions o( laws and ordinances governing lhis type of work will be compl <br />with whether specified herein or not. The granting of a permil does not presume to give authority to violate or cancel the provision of any other slate or local law regulating construction <br />That I am authorized owner of this property lo perform the work for which application is made and I comply with the Slate Contractors Law 1827 RCW and 296.200A WAC. <br />/1 <br />4 � <br />�� � ���'� -- �/ y �-% 5- <br />Owner Authorized A t ignature Date (Revised 9/2014) <br />�j� <br />�� <br />� ��� <br />