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• � <br />������ ����0������ <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 />SITEADDRESS:�—� —� PROPERTYTAX# pFRnn�Tu <br />:� S � � �0✓1� ���-'i�/4� (, � (� . <br />� <br />LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />OWNER `�i � � C �� Phone/E-mail `1 � ) — 2 � ���G�� <br />r� S ? �-� � ity/State/Zip -(�.� +L? � <br />Address � <br />PPLICANT <br />CTOR <br />> <br />Owner _ Owner's Agent _ Contractor _ Contractor�5 Agefl� _ T2f18f1t (musl provide a letter of consent from the owner to do work in �he space) <br />�'' <br />�IZ-OC;Q.I/Li I�S�i.l-�r�� �-�� State Lic. # Ki�dJ(�LrN�v��%%�`�City Bus. Lic. # <br />� /2, (�/ "' ���(�(J `1 !�l L ��C``L �' I � ��( Z PhonelEmail � i��' . SGl �—C %G�% <br />C <br />SS NAME CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATIOfvI CONTRACT PRICE OF WORK <br />Existing Use of Building S i—� <br />Proposed Use of Building <br />Building type: �Single Family _ Duplex _Townhouse _ Multi-Family <br />Type of projecl New _ Addition T_Remodel ✓Repair _T.I_= <br />DESCRIPTION OF WOf�K (addifional space provided on the back): <br />12L. -K'vc�F <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 firepiace <br />� Gas range <br />� Glothes dryer <br />� Rangehood <br />Exhaast fan <br />Heat ou�p <br />Boiler <br />� Woodstove \ <br />� Ducting <br />� Other _ <br />SPRINKLER / SUPPR�SS16P1 �l(S`��t�fi <br />� Number of Heads <br />HEAT SOURCE� <br />Electric Oth <br />_ Commercial <br />Sign Sprinl<ler Demolition_Change of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Numbei (#) of fixtures <br />� Toilet <br />� Bathtub <br />� Lavatory (wash basin) <br />� Shower <br />� Kitchen sink & disposal <br />I Dishwasher <br />i Clothes washer <br />`� � Water heater <br />`�� � Sink (service/bar/mop/etc.) <br />�'��� Backflow preventer <br />�'` urinal <br />I `'t Drinking Fountain <br />� �� Floor drain <br />, Grease trap <br />� � oof drains <br />I edical Gas <br />� Oth r: <br />I nereby certify that I have read and e mir�ed this application and know lhe same to be true and correct. All provisions of laws and ordinanc�s governing this type of work will be complied <br />with whether specified herein or not. he g'ranting of a permit does nol presume to give authority to violate or cancel the provision of any olher state or local law regulating consiruction <br />That I am authorized b�+%lhe o er i thisproperty to perform the work for which applicalion is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />`�� z-��l <br />Owner/Aut orized nt Signature Date <br />(Revised 3/2013) <br />