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� � �ERMIT APPLICATIO� <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 />SITE ADDRESS: PROPERTY TAX # P RMIT # � <br />7��� G�ti✓�fi�C. �►'. �IWGJ- (.'��.� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER ��� ��'1 (,Ev� .'�' G1'�J i' C C ` Phone/E-mail �J�Z 5- 5 % l- 5 3 5/ l.vl'�!��' !✓" ri;G� �e• � nc��� <br />Address 7��1 (�� •rtn i� (�y. CitylState/Zip l�G�t`�6' �,,; � `fr�.�U_� <br />APPLICANT: ✓Owner _ Owner's Agent _ Contractor _ Contractor�5 Ag611t _ T8f18f1Y (must provide a letter of consent from the owner to do work in the space) <br />, <br />CONTRACTOR --- '!%;�!��`1�' G L& I Lic. # COE Bus. Lic. # <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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 _Demolition Change of Use <br />DESCRIPTION OF WORK (additionai space provided on the back) : <br />� r �� <br />� t � I�i�-e, E x r.S � r �� ���: c�- vJ �`i� d'l-��'�' ���� I Z i� Z� �"� <br />���,1 f' � N <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show Number (#) of fixtures <br />A/C — air handling units Toilet <br />Forced air systems Bathtub <br />Gas piping Lavatory (wash basin) <br />! Water heater � Shower <br />Gas fireplace i Kitchen sink & disposal <br />' Gas range � Dishwasher <br />Clothes dryer Clothes washer <br />Range hood Water heater <br />Exhaust fan Sink (service/bar/mop/etc.) <br />Heat pump Backflow preventer <br />Unit heater Urinal <br />Boiler i Drinking Fountain <br />Refrigeration Floor drain <br />Woodstove ' Grease trap <br />Ductin Roof drains <br />Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM ' Other: <br />Number of Heads 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 to give authority to violate or cancel the provision of any other state or local law regulating construdion <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 18.27 RCW and 296.200A WAC. <br />-� , i / " i � <br />, <br />� : '" � �� ('Z <br />---_ � - �.�- -��_ :��l.��y <br />; - , ��� �. _-- _ <br />Ownet/Authori d Aqent S�ature Date (Revised 6/2012) <br />j; . <br />