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RMIT APPLICATIO <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 />SITE ADDRESS: l OZ� ���� fQ,,-�,'� <br />� \S <br />LEGAL for new construction: Short PlaUsubdivision <br />OWNER <br />ress � � Z.y <br />CANT <br />PROPERTY TAX # <br />P RMIT # <br />� i lr�l -f�"�?i <br />Lot No. (attach copy of long legai description) <br />Phone/E-mail Zo�� � l 3— C�Z�-13 <br />� <br />W a.-t�mo� Q� �v e> I City/State/Zip �v ¢�,�-�, W� �I g 201 <br />Owner _ Owner's Agent ZO Contractor _ Contractor�S Agefli _ T2f18f1t (must provide a letter of consent from the owner to do work In the space) <br />CONTRACTOR `/v Q�5-'C'��'n ��\p�,� � t-1C. <br />Address �C7�'j� r1,0Y��, � g�p---�, �jQ,�� <br />State Lic. # �('ESTE <br />,�YL � g o�/Email <br />CONTACT FOR PERMIT <br />�' g 12 �j�ity Bus. Lic. #�� � S.S <br />P°��o� `"1 ti t� — � gS�i <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �2, (o (� o. 00 <br />Existing Use of Building S�F� HEAT SOURCE: <br />Proposed Use of Building S 1 �� ��t5D�10.� � S��Q,(Y1 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 (additional space provided on the back) : <br />��.St' o�� �(b �� ,� Yid -�,i e� S d 10.C' � V S��P,�-rl -'� � n C( U clsL '. <br />C� �1� 1,+�c.. �u.rgy 2�0 t-t� rno d� l� <br />��� �����. �2o��-t-e-� 5�;�. i►-�v�fie-� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn �Alter <br />Show Number (#) of fixtures <br />A/C - air handlin� <br />Forced air s sten <br />Gas i in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes d er <br />Ran e hood <br />Exhaustfan <br />; <br />Heat pump <br />� Unit heater <br />I Boiler <br />rcerngeration <br />Woodstove <br />_Repair <br />units <br />s <br />� Other S� � a� -17L <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />! Bathtub <br />Lavatory (wash b� <br />Shower <br />Kitchen sink & di� <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/ <br />Backflow prevent� <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 comp <br />with whether specifed 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 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 />1 g 2�01 l.� <br />wn , r/Authorized Agent Signature Date (Revised 4/2015) <br />