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u <br />• <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 />ITE ADDRESS: r� � PROPERTY TAX # PE IT # <br />�jU� �,�s� ��--.r: ��,-�= Z`l o�oi cr�z o�S�v� �i�3 l�—CJZ� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />� ,/ <br />OWNER ��`-��%��'� -�- ���'� �):. �/�-� Phone/E-mail �'��� 7 % J � � ��� f ( ' t����'('�l��j��v�% <br />Address , 7� � � �- ����> > �J�-�� City/State2ip � (h-'-•� <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ Contractor�S A j0flt _ T@�8flt (mus� provide a tetterof consent from the owner to do work in the spaca) <br />CONTRACTOR �Y %':,'( ' " �.� -� (i-�'�Z`\ State Lic. # ����il ' l-`��rj,�,�%`�C� %City Bus. Lic. # U �Z" / <br />Address ��C� �- �� '. `�;.'` Phone/Email • /";�: ; � <br />) -� <br />1;� , i �� ' ,� � �t. � <br />� �. . .. � ` , Phone/E-mail i i .� i i �_ ,. � V' < .. � _ . , � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ?�;��a'� <br />Existing Use of Building S j��__ �=✓,r1 ,;.G�u_r `' �- -,-�';-y;,�?= HEAT SOURCE: <br />Proposed Use of Building �%�j,f' �= 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 (additiona� space provided on the back) : <br />, t <br />_, . <br />�_ ; ; — ; <br />' �f � �`� � If� i� � , i `� r`% , �; . . <br />,. <br />CU'�°�= -•�� ;; 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 />j Gas piping <br />; Water heater <br />Gas fireplace <br />j Gas range <br />; Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />I Boiler <br />I Woodstove <br />Ducting <br />j Other <br />PRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />I Lavatorv (wash basinl <br />Shower <br />Kitchen sink & dis <br />Clothes washer <br />Water heater <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 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 lhis property to periorm the work for which application is made and I comply with lhe State Contractors Law 18.27 RCW and 296200A WAC. <br />�'�-- 1l� �� Z��13 <br />Owner/ th e Agent ignature Date (Revised 3/2013) <br />' v� � <br />