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1 <br />�� . �ERMIT APPLICATIO� <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 />SITE ADDRESS: PROPERTY T/uc # TAKC�ofJ' : OQd I O P RMI # 'I <br />�G'I S 'rZ2,�ec>t,,.A�t- �'�,an_a�r WA 1�i�Lc.EL : b6��A-��97901 �00 � � �n `i" - /'l _�i� <br />for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />� �'�/�l'�11�M CF�Ct'F'4 ��! Phone/E-mail �{25' �]2� 2.2� '%� <br />dress <br />NTRACTOR <br />� <br />�City/State/Zip <br />.� <br />OWfI@f � Owner's Agent _ Contractor _ Contractor�S A9@flt _ T@f12f11 (must provide a letter of consent from the owner to do work in the space) <br />� <br />BUILDING PERMIT APPLICATION <br />L8�ILic.# <br />Phone/Email <br />ione/E-mail � �j - 2�j�j ' <br />ONTRACT PRICE OF WORK � R <br />COE Bus. Lic. # <br />Existing Use of Building �j�t/11i.�uLk�i CcFt=�'S GO y�AT SOURCE: <br />Proposed Use of Building S'1A4�Ul1�.S L��-i-E� Gd / Gas_ Eiectric other <br />Building type: _ Single Family _ Duple/x _Townhouse _ M/�yltl-Family ✓ Commercial <br />Type of project: New Addition �/ Remodel Repair J T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) :�N� <br />T IMp2���►r -r���sr�,�c.� �3(�t���i�L-�. <br />lrvcc.�/�,S !�. w �i� �-�- � � j�►"IS ��S , �161aT 1N l� �1���.,5 � <br />'CY1l N�2. Vj(,1LD ot>>` 4►J 1 NtPl�+�lL- �vl�l��-� . �-+ a�d SePa.i.�(-c- p�.- �,,�..'� <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 svstems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriaeration <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />I 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 />Sink (service/bar/ <br />Backflow preventi <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 governing this type of work will be complied <br />with whether specified 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 construdion <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />" l�/z��y <br />Owner/Autho �zed Agent gnature Date <br />! <br />(Revised 6/2012) <br />