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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 />APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM <br />SITE ADDRESS: ._ ,- PROPERTY TAX # P� M T# <br />EGAL for new construction: Short Plat/subd <br />jdress 3 tv� l� '��'Ur' <br />PPLICANT: _ Owner _ Owner's Agent <br />ONTRACTOR <br />idress r�U\ ci �: w�Y�� t\' <br />G � -C� . <br />Lot No. (attach copy of long legal description) <br />� Phone/E-mail - � — <br />City/State/Zip � � <br />_ Contractor�S Ag@flt _ TBl18f1[ (inust provide a letter of consent from the owner to do work in the spacej <br />��. L& I Lic. # S ; COE Bus. Lic. # — <br />� �� C���.� Phone/Email - (—1 <br />CONTACT FOR PERMIT ( <br />G��v"�,1L'... �lCv1%��� \31.ct0)�2 1 r.. � �i �� <br />1 ,l:t � �du��s ��CXc�'" �'�'� `� Phone/E-mail �.c` �� � <br />BU/LD/NG PERMIT APPLICAT/DN CONTRACT PRI E OF WORK ,� b. vc <br />Existing Use of Building ��;1� —�t CaC�CI�� HEAT SOURCE: <br />Proposed Use of Building ��V1 `� Gas Electric other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition Remodel Repair _ T.I.� Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : � L� L�k. y�.� v K v����� <br />`j ��y��'� � 1�Sfic� C'I c,�t-� � �.�. �--;'� ;.�� 11 <br />1 R�.. 1u v.� - l� t- u7� \� <br />MECHAN►CAL PERM/T APPLICATION PLUMBING PERMIT APPLICAT/ON <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show Number (#) of fixtures <br />A/C — air handling units Toilet <br />Forced air systems Bathtub <br />Gas piping Lavatory (wash basin) <br />Water heater Shower <br />Gas fireplace Kitchen sink & disposal <br />Gas range Dishwasher <br />Clothes dryer Clothes washer <br />Range hood Water heater <br />Exhaust fan Sink (service/bar/mop/etc.) <br />Heat pump Backflow preventer <br />Unit heater Urinal <br />Boiler Drinking Fountain <br />Refrigeration Floor drain <br />Woodstove i Grease trap <br />Ducting Roof drains <br />Other Medical Gas <br />SPRINKLER 1 SUPPRESSION SYSTEM Other: <br />Number of Heads ; 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 governing this type oF work will be complied <br />with 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 construction <br />That I am authorized by the owner of this property lo perform the work for which application is made and I comply with the State Conlraclors Law 1827 RCW and 296200A WAC. <br />� -�__1 _ � �� Z <br />Own rlAuthorize Agent Signa ure Date (Revised 6/2012) <br />