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a <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 ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: , ' / PROPERTY TAX # P MIT <br />��t`—�'!'{l��1=5 ��V� C`l"L(->�%�.,�l�l��> >r�r �����"'�� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER j i�`�I C�� r'rY�.��` +-( �� i' <br />J", � � L t/�( �T . Phone/E-mail <br />i/� �/� <br />Address� ����L`L�' �L-�•� I�l � j C'(T�2 /��� � °� ��� City/State/Zip �. `f �a `� I �� �l_ 7-t `l� �C <br />� <br />APPLICANT: _ Owner _ Owner's Agent � Contractor _ Contractor�S Ag@�l _ T2f18�1 (mus[ provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR }�, �.�.—r I j �' � C� L' . L& I Lic. #!� i� %-j;�i�i !��; y i�� � COE Bus. Lic. #�%�/� <br />Address � � �_' � �Jp r ��!-��T� � i'tf ( � � � � �' � � � � Phone/Email �` i i I C n � �i � �c� /i�'1 <br />/� llil�C^ �� % <br />.%Ir°if �}1', ;L,�;j I I�C�I� � �," <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building <br />CONTACT FOR PERMIT � <br />_ � ;/.�i-s� T'f�'r:t,,y, � — i� � �1�: �� _. <br />�"; j;� <br />/ii�::�' �. , . .. . <br />Phone/E-mail , T,� ��'i' . 'i �', i :^r <br />CONTRACT PRICE OF WORK ` �{ �, rf `C' � <br />Proposed Use of Building � <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkle <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />HEAT SOURCE: <br />ition Chanae of Use <br />/2� , ��c �ir_ �C�—� r� � � ;� � > j=%%- ;� �'�;F 1�,=� � :� ,i.� .. 5 � /��-� ���<< - <br />_, ,. � � _ <br />�I 1 , � <br />� , , �, <br />/i � ; �T�� 1 l<<'/ 1 /�. c�" <�_ J'-� � ! l � , , =��`,! JII� iL `lf5 l� ;'�%� f`� /i �%�C"� , <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn �Altera <br />Show Number (#) of fixtures <br />A/C — air handlin <br />Forced air syster <br />I Gas piping <br />Water heater <br />! Gas fireplace <br />Gas ranqe <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />� rcerrigeration <br />I Woodstove <br />Ducting <br />( � Other 1�c'c'� '�lr <br />SPRINKLER / SUPPRESS <br />� Number of Heads <br />on _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixiures <br />units Toilet <br />s Bathtub <br />Lavatory (wash basin) <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc. <br />Backflow preventer <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 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 tl�e 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 />1 � �/ ' i 'Y ' j j ' ' 1`� ,��•_ .� I�G_ <br />.�-� / 11 / � � � - � ;� - � / "�. L ���-� U �l % /- � � <br />�kYwraerl uthorized Agent Signature � Date � (Revised 6/2012J <br />