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• • <br />PERIVII°T APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLIiION <br />CITY OF EVERETT PERMIT SERVIGES <br />3200 Cedar St., Evereft, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />: ADDRESS: PR�PERTY TAX 1# PERM�/{,T,# ` <br />�� � w, !v '� �,;�tc,�� C.��'� �'� � i '-r`��:-�i:: , jf-;._tt.�� � VU � <br />AL for new construction: ShoR PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER �._ �n �-E � _.1,.C• , _ _ � � <br />idress � <br />PPLICANT: <br />NTRACTOF <br />ress _ , <br />Owner _ Owner's Agent <br />�� , ��" _.� . _'�+..:.i <br />Contractor <br />� <br />� ``' � �C.' <br />BUILDINC"a F'ERAVIIi APPLICA'ilO1V <br />_ � <br />hone/E-mail .�f)��r..�.�'-4i •� •,.� � �t �: � � rtE:":'v� c=...:: � �, �l , <br />�c� . �City/State/ZiP ��.� �ro�� i-= � . 1A � � , f"� `�. ��' `� � <br />Contractor'S A98f1t _ T0f18f1t (musl provide a letter of consent from the owner to do work in ihe space) <br />State Lic. # Bus. Lic. # <br />`�� \'(��-�'--, -. ._z�J�;�r' :'� : �, <br />t���y,��,� � Phone/Email �ZS- �7�-1_=� �-?��-�CC? - <br />CONTACT FOR PERMMT <br />�vl�i%� S 7 `i `� `_� Z .' � -7 �.—�`� �� �G'C; <br />?hone/E-mail <br />PRICE OF WORK <br />ExistingUseofBuilding�,�•-: ��,� �,r�_�4`����_� � <br />Proposed Use of Building <br />Bui!ding fype: _ Sirgle Family _ Dup!ex _To�a�nhousa � �nulti_Family �_._ Commercial <br />Type of project: New Addition � Remodel Repair _ T.i. Sign _Sprmkier <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� . `:J.,,�. �..,.T .�t-t�...jr.� -� ��7r=.(•�--1 �Y^��� : C:%�-'c'�iiL��.� y ��-t°��,'� -•� <br />�`;L'l l��'� �vY. <br />Y <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C - air handling units <br />I Forced air systems <br />; Gas piping <br />j Water heater <br />Gas fireplace <br />i Gas range <br />Clothes dryer <br />Range hood <br />j Exhaustfan <br />j Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLEf2 / SUPPRESSION SYSTEM <br />� Number of Heads <br />HEAT SOURCE: <br />Gas <br />Demolition Chanae of Use <br />Y ` ` <br />y I <br />� e � i��; Ct'_ `�- c` <br />PLUIVlBING PER9VAIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Sflow Number (#} of fixtures <br />� Toilet <br />! Bathtub <br />Lavatory (wash basi <br />Shower <br />Kitchen sink & dispo <br />Dishwasher <br />Clothes washer <br />V�later heater <br />Sink (service/bar/mo <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 a�d 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 noL The granting of a permit does not presume to give aulhority to violate or cancel the provision of any other stale or Iocal law regulating construction <br />That I am authoriz�d 6y the owner of this roperty 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 />^ � , �� <br />; ��, �l �—� ( ;j �� � - <br />Owner/Authorized Agent SignaYt�re �" D'ate (Revised 3/2013) <br />