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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, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />• , �. v i . i �'� \ ., '-t � ; �, ; :', � 1" ERTY TAX # _ ^ PERMIT # <br />ADDRE : PROP <br />:��� ,, ��,uc ;�� , ci�,�E�� i�►��:�_:4�t_>c ,5I'iD"� � D1`Z <br />EGAL for new construction: Short Plat/subdi� <br />WNER I `��_�� :�\r \� 1 I \L��.) � <br />�dress � � u i'+ C�i c`� 1 <br />�'';,'� � i�v(;'�,, <br />PPLICANT: � Owner _ Owner's Agent <br />ONTRACTOR C�,.�l1�V <br />s <br />No. (attach copy of long Iegal description) <br />� <br />Phone/E-mail ULS-��� -1,' »� � ri,:;iZ�„iti�L�� �5��' ��' ('lv`. � _'• �'i�i ,�„t <br />� � . <br />City/State/Zip �,V � W� ��� VJ f1 ��l ti i�u -' <br />C011ti"BCfOf _ COf1tf8CfOf�S f�92fli _ TBfl2flt (must provide a letter of consent from Ihe owner to do work in the space) <br />BUILDING PERMIT APPLICATION <br />L & I Lic. # <br />Phone/Email <br />COE Bus. Lic. # <br />�'' �,� ,,': � Zti,1 `� ,, �,,�:� ,�., � � ?..� • �`t� -i`;;':>>�� � ? �`� <br />� � . <br />ione/E-mail ��%t,,�j'rL�S;��^�?S.,n��✓1=.��;�1 �i-is{1"���Q. G�r L� <br />�NTRACT PRICE OF WORK 41�ZL <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building 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 <br />DESCRIPTION OF WORK (additional space provided on the 6ack) : <br />��.:,�C� ������:>t'��.,:���y y�,L ti,"�.� 1���' �a,tiL L�'!.'.� 4�l�,�.� }� �.::^l�rl ��'� • �Y ;�R <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />� Forced air systems <br />Gas piping <br />Water heater <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />� SUPPRESSION SYSTEM <br />Number of Heads <br />of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />Bathtub <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/E <br />Backflow preventer <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 noL 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 authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296.200A WAC. <br />� , r�. <br />���' �' �� ��z <br />-� ✓u.�� � �Z� �1 <br />OwnerlAuthoriz Agent Signature Date (Revised 6/2012) <br />