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• <br />• <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL./PLUMBING/SIGN/SPRINKL�R/DEMOLITI�N <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: � PROPERTY TAX t� P�RMIT # <br />� � 3 3 lJ � Y� t2 L t/ � �3 %u ��' -�,-� �, �� ; �$ � � �% <br />LEGAL for new construction: Short PlaUsuhdivision Lot No. (attach copy of long legal description) <br />OWNER (�'t�� ✓ � C.3'/`�/til'� Phone/E-mail ��� C% ' �,jl - �%% i � '='�'� =' �C', �• <br />Address � ;� 3 0� Cf �^ �s T /�f� �L City/StatelZip ���,/ ' '�� � ,%Uj7 � ,,Z ` <br />APPLICANT: t/Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �musi prowde a iener or consenc �rom me owner co do work in �ne space� <br />CONTRACTOR S'd- S � pG � l/�1�: (���IJi- i4i� State Lic. # Cit Bus. Lic. # <br />Address r►'���E�1% r.�� (' ���/ 1� Phone/Email <br />TENANT BUSINES , NAME CONTACT FOR PERMIT C� I� nn J,�a� S�• <br />{— � � ( �p, ��` <br />�� ✓( ��� I Cl 1 i� �� ��-l. �'� °� �" �� Phone/E-mail Z, �� Z TJ �� ��� � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ` ��' ��' �' <br />Existing Use of Building <br />Proposed Use of Building <br />Building type: _ Single Family _ Duple Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New Addition �Remodel _ Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK {additiona� space provided on the back) : <br />. <br />O��' f\ vC'!= <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of flxtures <br />A/C — air handling units <br />Forced air svstems <br />Water heater <br />Gas range <br />Clothes dryf <br />Range hood <br />Exhaust fan <br />Heat pump <br />Boiler <br />HEAT SOURCE: <br />Demolition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Typo of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />i Toilet <br />Kitchen sink & <br />Clothes washer <br />Water heater <br />Backflow preventer <br />Urinal <br />Drinkinq Fountain <br />Woodstove Grease trap <br />Ducting ; Roof drains <br />� Other ; Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads Other: <br />I hereby certKy that I have read and examined this app:icatior and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />V-ith wh�ther �pec�ed herein or noL The granting of a permit does not presume to give authority to viotate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by lhe owner of �his property to perform tha work for which application is made and I compiy wkh the State Contrectors Law 1827 RCW and 296200A WAC. <br />�/;i./t�t � �..*�cfZ� �./Y%c�' �t� 1.�-:,�ii <br />� nerl uthorized Agent Signature Dat <br />�L <br />(Revised3/2073) �i� <br />