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� <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 />SIT.E-�QD�R�$:� ��C �� � ._}�— � � / IPROPERTY TAX # <br />�•� 7 0< TT <br /># <br />LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />OWNER �' j'� %%� Q' � f y CC S Phone/E-mail � 01 �j -- � �2 ^ � .� � {a <br />idress S' (�'/'!') -� <br />PPLICANT: �Owner _ Owner's Agent <br />R G <br />ress <br />Contractor <br />BUILDING PERMIT APPLICATION <br />ICity/State/Zip �V'�f'� '� � ��� � ,� -ZC� � <br />�— <br />Contractor�5 A92fll _ T@Ila�f (must provide a letter of consent from the owner to do work in the spaca) <br />State Lic. # <br />Bus. Lic. # <br />�Phone/Email <br />ONTACT FOR PERMIT <br />�s �� �/ " L1 <br />hone/E-mail �QI�f �`'�- , � L�'rJ — /n:�' <br />ONTRACT PRICE OF WORK <br />Existing Use of Building � �l t— �� � <br />Proposed Use of Building 4r(!'� � <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 back) : <br />Rt� p lc�c �-�X � s-� �iC� � f s� '� � �� ss '� �' ��rc��u,? <br />.�� r� X C�� `� \� ��1G�'o r,c� <br />HEAT SOURCE: <br />Gas Electric � Other <br />Demolition Change of Use <br />� <br />w�� <br />MECHANICAL PERMIT APPLICATION PLUMBING 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 />j Gas piping <br />� Water heater <br />Gas fireplace <br />j Gas range <br />! Clothes dryer <br />Range hood <br />Exhaust fan <br />I Heat oump <br />Unit heater <br />Boiler <br />; rcerrigerauon <br />Woodstove <br />Ducting <br />( Other <br />PRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />I Bathtub <br />Shower <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/ba <br />Backflow prever <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />a <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 />wilh 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 m a orized 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 />a'-���-- �� <br />.a� � a/ � 3 lz <br />Owner/Authorized Agent S gnature Date (Revised 3/2013) <br />