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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 />ADDRESS: <br />PROPERTY TAX #t CJ 2 Z <br />0 <br />PE�MIT # <br />1'��;, J f �I�fi� -- r�; <br />LEGAL for new construction: Short PlaUsubdivision �Zi V{?jC�GI�� �c�� K Lot No. Z� 3�attach cbpy of long legai description) <br />OWNER y� �.(�,rQ� �; � Phone/E-mail ��'��C� `Z� �j <br />� <br />Address �' � ��- I �t l� City/State/Zip � ��Yji.uc;�� G� c=�C;_j <br />APPLICANT: �Owner _ Owner's Agent _ Contractor _ Contractor�S A(Jelli _ T611811t (must provide a letter of consent from the owner to do work in the space) <br />ONTRACTOR <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />IPhone/Email <br />CONTACT FOR PERMIT <br />Phone/E-mail J�Y�1"���L°f�� <br />CONTRACT PRICE OF WO <br />Existing Use of Building _ ��IZ ����,'� Q�� �(���� <br />Proposed Use of Building <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) :�eYy�,eu� �r��i1 t+� � <br />�he�'��-cc� ��.,�.�c� �z�1��7 w�� �/� F��e �-�-c'�l �-rx.N <br />���.�� ff��� `fie'.L ��l('�r�� LA.%L1�L5 l;�.ic� �/Z `� iC�� <br />ri cJ'�c�l. � ��5� �f1 �i" V i�C 1 <br />Bus. Lic. # <br />���j'-�6(� ..��'�' <br />� � :- �� 4�1£.�r�w...c.� � c..� � �1 <br />�K LybL=� <br />HEAT SOURCE: <br />Othe <br />Demolition ChanSe of Use <br />��,Lc�cf7i' i✓1S�t1� ylP� �OE` ; <br />aPc� �il ��,v✓�s �,. <br />MECHANICAL PERMIT APPLICATION r- PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Aiteration _Repair <br />Show Number (#) of fixfu�es <br />A/C — air handling units <br />!. Forced air svstems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />rcerrigeration <br />Woodstove <br />Ducting <br />( Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />, Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />� Toilet <br />� Bathtub <br />j Lavatory (wash basin) <br />I Shower <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/ <br />Backflow preventf <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />) <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. Th 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 an . uthorized by the o er f t r perty 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 />- � 2-�� �. ' z <br />� � <br />Owner/ thorize Agent Signature Dat (Revised 3/2013) <br />