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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 />SITE ADDRESS: PROPERTY TAX # PERMIT <br />:.�7//�1 ������. �✓�' �c��'���o»'aaa�� �1A � Oq- b�a' <br />LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br />OWNER j+ ' �v � �Z�+ Phone/E-mail / - '`7''/�,�"�-�' � ' .._1'j � <br />Address j�(�' • / �G"7 ' � City/State/Zip ,$an ' � � �/' <br />APPLICANT: _ Owner _ Owner'S Agent � Contractor _ Contractor�S A9211� _ T@fl8ftt (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR �i - `. �� � a, L& I Lic. # L1i�. � /%� j JQC• ' COE Bus. Lic. # 4�% � E� <br />Address � � 1% � /;�o �i�+i,��^` L",%$Le � ! � � L' 7 ,%T2�� ,�; �/+7,e�'i� /c'r'Y'".s� Phone/Email ��,�, j� �7� ��` � f' <br />���i`' � �✓�� % � � ,..�.� �+, <br />.�" PhonelE-mail t, /c"_ d�� �j�•yy C. �vC�j'c? /C %, <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK'�r %��' 7, �>�.3 <br />Existing Use of Building L� �/�i � r'- HEAT SOURCE: <br />.�� : � <br />Proposed Use of Building C'' /�� � G„C Gas_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family k. Commercial <br />Type of project: New Addition Remodel � Repair _ T.I. _ Sign _Sprinkler _Dem� <br />DESCRIPTION OF WORK (additional space provrded on the back) : <br />1���%a r� yo-� �� cf rrro;� r, �'�:�L 11 ��' �"', p tr r��v •C%�,� �°�'r 1''�--_ <br />MECHANICAL PERMIT APPLICATION <br />Type 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 fireolace <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Gas range Dishwasher <br />Ciothes dryer Clothes washer <br />Ran e hood Water heater <br />Exhaust fan Sink (servicelbar/mop/etc.) <br />Heat pump Backflow preventer <br />Unit heater Urinal <br />Boiler Drinking Fountain <br />Refri eration Floor drain <br />Woodstove Grease trap <br />Ducting 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 goveming 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 construction <br />That I am authorized by the owner of this prope perform the work for which application is made and I comply wdh the State Contractors Law 18.27 RCW and 296.200A WAC. <br />,�/�� ��� / � <br />Owner/Authorized Agent Signature ate (Revised 6/2012) <br />