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• <br />� J <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 />ADDRESS: �� 2O 1 IPROPERTY TAX # <br />�I 021 fn da� �� �U <br />PERMIT_ # <br />0 <br />EGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />iWNER �/� 1 C� �l �� Q�� Phone/E-mail � 2 S 3� rJ ��—] `L$ <br />ddress � �2 ( '�Yf (�a �'�/Q,nv Q� City/State/Zip ��/Q,�� � � Fj20 l <br />PPLICANT: _ Owner _ Owner'S Agent � Contractor _ Contractor�5 A9Bflt _ T@fl2fli (must provide a letter of consent from the ovmer to do work in the space) <br />NTRACTOR �/�( Qy�'Q,�' (� S O�GL� �Y <br />ress �I O�11 -�-t0►'�_ (Zd S"C2.f�, t�jQ,l <br />state �ic. # W ESTES'�q1�fO City Bus. Lic. # OSL1� SS <br />�1G�YY1' � �g� hone/Email '?j�pQ � �j (p — 0 � cJ I <br />CONTACT FOR PERMIT K�Q �w��nsclar i nc _ <br />� � � �G LcCi �. 1 ke.�r�cir o. �y �flm <br />Phone/E-mail �� 1 y ^ ����( <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � 2-� ��1 � <br />Existing Use of Building ��+ <br />Proposed Use of Building ^(DO��D'!7 SC�CLr' �V <br />Building type �{( Single Family _ Duplex _Townhouse _ Multi-Family <br />Type of project: _ New � 0� Addition _ Remodel _ Repair _ T.I. _ <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� r�s'-t a�.,l r o c�v� `��( sy srt-e. m <br />�1�1> 1T2�0 �1-1�E rnadvl.a� <br />�� � 1�Y 1 S2 o�L,� �-t-�k.. ir,uQ �'t-eX <br />MECHANICAL PERMIT APPLICATION � <br />of Project: _New _Addn _Aiteration _Repair <br />Show Number # of fixtures <br />A/C — air handlin units <br />� Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />i Gas ran e <br />Clothes dr er <br />Range hood <br />� Exhaustfan <br />Heat um <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />_ Commercial <br />n Sprinkler <br />HEAT SOURCE: <br />Other <br />ition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtuies <br />( Toilet <br />Bathtub <br />Lavatory (wash basin) <br />i Shower <br />Kitchen sink & dis osal <br />Dishwasher <br />Clothes washer <br />, Water heater <br />Backflow preventer (inside b <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <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 comp! <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 construction <br />That I am uthorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296.200A WAC. <br />,�-�J l � � / l5 <br />Owne /Authori ed Agent Signature Date (Revised 4/2015) <br />