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� <br />PERMIT <br />• <br />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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: .C.y� PROPERTY„1'AX # RJIAIT # <br />%i'�O\ � Li �v� vo S o� `-�aoZa 23oc� �_I_� Ci��-�� <br />1L for new construction: Short Plat/subdivision ��'`��� �� U A Lot No Z3'��(attach copy of long legal description) <br />i .`,y� <br />dress y %(� � � y � <br />'PLICANT: �,Qwner _ Owner's Agent <br />)NTRACTOR . , O W n� <br />dress �p fYv�_T.,M.�(.i.(�, <br />Phone/E-mail 3 �Q <br />City/State/Zip <br />z.�- s�s�a / ��� <br />�- u F� ��S �.o <br />COf1�f8CiOf _ COf1t�8CtOrS /�98f1Y _ T2f18f1� (must provide a letter of consent from the owner to do work in the space) <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building �p �l�f�.. � <br />L 8 I Lic. # COE Bus. Lic. # <br />Phone/Email L� `% -' S � �� " � � `J � <br />CONTACT FOR PERMIT <br />�/' ?jv�(Y,c'iut.,l1 S <br />t;�`E� h rv� 1't �� <br />Phone/E-mail �`> (,;, �� '� � t Z � ' �`� � � <br />CONTRACT PRICE OF WORK �" U� "'' i0� <br />Proposed Use of Building �0�� ��� � � <br />Building type: �ingle Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel 'J� Repair _ T.I. _ Sign _Sprinkle <br />HEAT SOURCE: <br />of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : ` � wov �M �� <br />p Q, �YL�+(� 4 S�, I 5 1..� /�Yir� 4.� <br />t��.-��G..C,� f�� ��5� „�. y, � an�,�-�. <br />ar�U�— J�C�\ � �J . 1�a (� �l , {� �RVL�v\ v�� C\ . <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of Fxtures <br />..�.. - a�� � �a� �� <br />Forced air sy: <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ranae <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Shower <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/i <br />Backflow preventE <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 goveming this type of work will be compfied <br />wfth 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 consVuction <br />That I am authorized by the owner of this property to perform the woric for which application is made and I comply wilh the State Contractors Law 18.27 RCW and 296.2DOA WAC. <br />, �� � <br />�- 3 � � � <br />ner/ u orized Agent ' a ure Date (Revised 6/2012) <br />C �`� <br />