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�ERMIT APPLICATI� <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 />S`IT}E ADD�RESS; �/ /� / �j PROPERTY TAX # PERMIT #�f <br />d�/'�� /`:.�/r��� � �� - t� !� t`,- /= � � � !/!,/ f� �S %� t? �� c�',% `�Sc7 C. � �7 DC? �"J `�-f � j `T � li �� � �n <br />� �� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER � ��/��� Q���/��j� (%� /%�/ � ` Phone/E-mail yZ,�G �,� � L Z <br />Address �/�/ � Q�.l� 7��(�C, C City/State/Zip �l���� <br />APPLICANT: �Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �must P�ovide a iener or�on5ant trom ine owner �o do woric in tne SPace> <br />CONTRACTOR State Lic. #�i��'t.S/j��(� �`�L���City Bus. Lic. #��j ,i��� <br />ress <br />.l� �, ,�`i/:�/���r�a,� liil <br />BUILDING PERMIT APPLICATION <br />I Phone/Email <br />ONTACT FOR PERMIT��� �� �!'�" <br />ione/E-mail 7 ��J �8 6.3�(� �lJjt�/1�16 �(��/9. l���7 <br />ONTRACT PRICE OF WORK t�`'�-' �', '`�� <br />Existing Use of Building <br />Proposed Use of Building G <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 />S'/,G�i�/�? <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />I Gas piping <br />Water heater <br />� Gas fireplace <br />Gas ranae <br />RI <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Ketngeranon <br />Woodstove <br />Ducting <br />Other <br />' SUPPRESSION SYSTEM <br />Number of Heads <br />,T SOURCE: <br />Other <br />molition Chan4e of Use <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Aiteration _Repair <br />Show Number (#) of fixtures <br />! Toilet <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <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 lhis application and know the same to be irue 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 authorify to violate or cancel the provision of any other state or local law regulating construction <br />That I am ut rized by the owner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. � <br />� � <br />��/ s �,� � <br />Owner/Au ri d Agent Signature Date (Revised 3/2013) <br />