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• <br />u <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 />ADDRESS: � V�L � �/�+%a pROPERTY TAX # PERMIT # / <br />� „�7 % �(aG �� AV� �7 4" 2�1 C ������ V <br />1L for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />ER �V't � E �l /�G:.i S /N � Phone/E-mail y�S�._. ,)� � - // �'-'S <br />u 2 �• !�j jZL i1 ,l) ti�� `IJ �City/State/Zip � V`�12. � � � � tt�'yR �J' � � c� / <br />f: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �m�sc Pro��de a iener or �onsen� rrom u,e owner �o do work m cne SPa�e� <br />fOR ��/✓L ���S l C,��k S L& I Lic. # ��o� / p .L, /L COE Bus. Lic. # <br />c� _= i / 3���i. S� I19iy�L C'�C�j�—' Phone/Email 1�,? .� 3��— t.li- J Z 3 <br />�GA � �CJ�- �/'�4,�'i �7 Eit/ i <br />BUILDING PERMIT APPLICATION <br />Phon/e���S' � ,�_j "�7%��J <br />CONTRACT PRICE OF WORK �j�� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Changf <br />DESCRIPTION OF WORK (additional space provrded on the back) : <br />� � �- %�'� G ��—`� � �,n�if rv�onw�i' <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 fireplace <br />Gas ranqe <br />... <br />Unit heater <br />Boiler <br />Woodstove <br />Other <br />' SUPPRESSION SYSTEM <br />Number of Heads <br />of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#1 of fixtures <br />Wates heater <br />Sink (service/bar/i <br />Backflow preventE <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease tra� <br />Medical Gas <br />Other: <br />Other: <br />I hereby certi(y 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 specfied herein or not. The granting of a permit does not presume to give authority to violaie or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner of this property to perfortn the work for which application is made and I comply wdh the State Contractors Law 1827 RCW and 296.200A WAC. <br />�� t /� <br />Owne uthorize Signature Date (Revised 6/2012) <br />