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� � <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 />ADDRESS: � j.�� `X�,v(e�� <br />C � � lC.� <br />ress <br />TAX # <br />for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />2 � (n " � r I-(�j �12.y� Phone/E-mail � � �` `� ` �' 7 � � <br />� , ,�' � V� � �r �/l�C(,u City/State/Zip �'���- . � %} . �� �� <br />Owner <br />_ Owner's Agent Contractor <br />� !'1�- � � �v�l` ` 1�1 C. . <br />�� �'1 c��/ �ih:�'.- C <br />BUILDING PERMIT APPLICATION <br />� <br />Contractor'S A92flY _ TBf18t1Y (must provide a letter of consent from the owner to tlo work in the <br />State Lic. # � (� ` �ity Bus. Lic. # (� ��Cj <br />��-�+w` ��� Phone/Email � � ? J � �� �� <br />CONTACT FOR PERMIT <br />�Il�t(.t��l� �b�l�x(<� <br />PhonelE-mail � �� �� — � � � � r' <br />CONTRACT PRICE OF WORK _ i �, '� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric Other <br />� <br />Building type: �Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Tvpe of oroiect: New Addition Remodel Reoair T.I. Sian Sorinkler Demolition Chanae of <br />DESCRIPTION OF WORK (additiona� space provided on the back) : <br />^ � � <br />1 ����; i�.��1; � �� ��1� �� - �� �., �v� �, �� _ �. � 1 � �. <br />'� ��� �" � ,, <br />MECHANICAL PERMIT APPLICATION � �\ PLUMBING PERMIT APPLICATION �, <br />Type of Project: _New _Addn _Alteration � <br />Show Number (#) of fixtures <br />A/C — air handling units <br />'1... Forced air svstems <br />Gas fireplac <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />tterngeration <br />Woodstove <br />Ducting <br />Other <br />NKLER / SUPPRESS <br />Number of Heads <br />r Type of ject: _New _Addn _Alteration _Repair <br />Show Number (# of fixiures <br />Toilet <br />Bathtub <br />L <br />Urinal <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />7 <br />I hereby certify tha have r9�ad and examined this applicaf n and know the same to be true and cortect. All provisions of laws and ordinances goveming this type of work will be comp <br />with w ther spe ed he i� or not. gran of a pe it does not presume to give authority to violate or cancel the provision of any oiher state or local Iaw regulating construction <br />a I authori etl by t�;wner of t i prop to perf the work for which appiication is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />t� l i c� <br />O Autho e Agent Signa re Date (Revised 9/2014) <br />