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\J <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 wuvw.evere a.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: �(./��x �I�tJ��� cJ"� PROPERTYTAX# �R�IVxT�# <br />� cy, �`c�o� <br />for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />� '1.O -�'.f',� �` O s�P Sir. \ '�1 � �-� �- � G �^I �v 1 <br />. T� �(i (� �� p` y� n Phone/E-mail S <br />�i3�`= I�c�`� <br />���.1 <br />:_,�(, Owner _ Owner's Agent _ Contractor _ Contractor�S A9e�t _ T2�2flt (must provide a letter of consent from the owner to do vrork in the space) <br />� <br />BUILDING PERMIT APPLICATION <br />Use of Building <br />L & I Lic. # <br />Phone/Email <br />CONTACT FOR PERMIT <br />��.t.4-�� <br />{.: r"�y.� ' -' <br />COE Bus. Lic. # <br />-�� - �h� 4z� �3�-d��t <br />��wlav� �n � Il (�fciSi'�C�v�_c' i <br />PRICE OF WORK <br />�roposed Use of Building � Gas <br />3uilding type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />fype of project: _ New Addition _ Remodel Repair _ T.I. _ Sign _Sprinkler _Den <br />DESCRIPTION OF WORK (additional space provided on the back) :�� ,�,� �, n e� � f rvl i-Itc�� <br />S i de o � }-Icu Se t� d 5a�.� �� �'lcte 5�.� � � +e ;� I�. _ �, {t� {..� d - <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />, A/C — air handling units <br />� Forced air svstems <br />Unit heater <br />Woodstove <br />Number of Heads <br />HEAT SOURCE: <br />Other <br />lition Change of Use <br />1Zao m �A-dc�i-F`Pv� C'aSt <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteretion _Repair <br />Show Number (#) of fi�rtures <br />Toilet <br />Bathtub <br />Shower <br />Backflow prevent� <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 goveming this type of work will be complied <br />with whether specified herein or not. The granting of a permd does not presume to give authority to violate or cancel the provision o1 a�y other state or local law regulating construction <br />That I am authorized by the owner of this property to pertorm the work tor which application is made and I compry with the State Contradors Law 18.27 RCW and 296.200A WAC. <br />-� <br />� ' ���/�� /�,�/� <br />wner/Authorize Agent ignature Date (Revised 6/2�12) 1> <br />l� <br />