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Yw� <br />�ERMIT APPL.�CATIC�� <br />BUILDIN�/MECFIANICAL/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 />ADDRESS:_.J <br />� "3 l � �'�,�� � �� <br />�L for new construction: Short PIaUs <br />ER �� �i� _ ( � I `7 <br />�S r -� � °-� r L � � <br />APPLICANT: _ Owner _ <br />CONTRACTOR � <br />Address <br />�,: <br />�� <br />Contractor <br />PROPERTY TAX # <br />�c�-�05 <br />Lot No. (attach copy of Ibng legal description) <br />� Phone/E-mail �(�` Cj L� � C� :� 1 G' �,� j�j � C� C <br />--.. City/State/Zip � � , i-� � � � .% �i- � � / ` — <br />_ Contractor�5 Aj2�l _ TBflBflt (must provide a IeQer of conseN from the owner to dp work In the space) <br />State Lic. # City Bus. Lic. # <br />Phone/Email <br />__....._ . . �..... , ,� _ � '� �} <br />`� ' � � � � <br />Phone/E-mail <br />BUILDING PERMIT APPL CATION CONTRACT PRICE OF WORK <br />Existing Use of Building �� 1 � °' <br />Proposed Use of Building � � C� l <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family ,�Commerciai <br />Type of projec#: New Addition Remodel '-1 Repair _ T.I. _ Sign �Sprinkler _ <br />DESCRIPTION OF WORK (additional space p�ovid�d on the back) : <br />``''v �-� �'`� �` C C CG �J � ) � L� ���� `� � l. ."; � ��.' r� , . <br />.� <br />MECH14NICd4L PERDAIT APPLICA7' <br />Type of oject: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />A/C - air handling units <br />Forced air svstems <br />vvater neater <br />Gas fireplace <br />Gas range <br />lothes dryer <br />nge hood <br />Exh ust fan <br />Heat mp <br />Unit hea <br />Boiler <br />Refrigeration <br />Woodstove <br />Ductinq <br />HEAT SOURCE: <br />Gas_ Electric Other <br />_Demoliti4n_Change of Use <br />. _ PLUMBI � PER JT; APPLICATI <br />Type of Pr 'ect: _New _Addn ,_,Alteration _,Repair <br />Show Number (#) of fixfures <br />\ I Toilet <br />ower <br />chen sink & dis <br />�hwasher <br />>t s washer <br />ater ater <br />Backflow pr enter <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />n <br />� Other � Medical Gas <br />SPRINKLER / SUPPRESSION S STEM 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 spec�ed 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,l am authorized by the owner of this pr9�iy to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />r � � <br />`�� �� � � ` �� �,� � �, � �-- �=�- / S <br />Ow erl uth�rized Agent 5i'�nature Date (Revised 4/2015) <br />L� <br />