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� <br />� <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 />��� <br />E ADDRESS: n PROPERTY/ ,TAX It y�J /., P IT # r I <br />-�f�f'L'tC,'l`�L ,�L'� ---- VL.� �l / �•J ( L�V� (ZL�L� I/��l�i.� �J � 1 <br />EGAL for new construction: Short Plat/subdivision <br />IWNER �L��(nIG V 1 L��iG.� ��-L <br />ress <br />ICANT: <br />� �, <br />1 �'QC�t�C r1(/'e. <br />_ Owner _ Owner's Agent � Contractor <br />��-M, C1c'�:'riix C.fe) I.G�C'�(1C <br />r�,� 32c5 , K; r I� aivl , c� ;� .' <br />L��p-t`� v tc.��, � � <br />BUILDING PERMIT APPLICATION <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail <br />City/State/Zip t"' L�(� f(' <br />L��I <br />C011YfBCtOf S/�g2f1t _ TBf18f1t (must provide a letter of consent from ihe owner to do work in the space) <br />State Lic. # CFM ii�'Hc;�j(o�(�;�� City Bus. Lic. #��7'�� <br />� � Phone/Email `�Z�- rZl- IZti3�J��z,�. �,�,��tii-�-►�e.� <br />CONTACT FOR PERMIT �je���, rNN ;v Ci. ��'� <br />r <br />PnoneiE-ma�i y2�-i ��- I2•� 3 J� re.v� �' C �-l'1-HV�C {Z .c� �� <br />CONTRACT PRICE OF WORK (, ,� i l�(x�) <br />Existing Use of Building Cri,.����(v1C; C�C;1 HEAT SOURCE: <br />Proposed Use of Building Gas Electric X Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair X T.I. Siqn Sprinkler Demolition Chan e of Use <br />DESCRIPTION OF WORK (additional space provided on the back): 7�} t � � 1 (�Ein; f�7j, �- 6��StP�� �\2�;� ��,'v� � <br />" � (�, r; � � <br />(.t„�� L�j;(�i'I.v�,�k G:.'41 G�Y� ��v'j `�"0� '.Cfv1Metc��6l� Y- i , �%�-�C�l�r iJl'l�� ��o �L Cc' i �,�f� ��Y"IDv,'l �C� <br />V <br />1t"j �%Ci��:� �c'.rC��� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn �Alteration _Repair <br />Show Number (#) of fixtures <br />' A/C — air handling units <br />' Forced air systems <br />Gas piping <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 />Refrigeration <br />Woodstove <br />Ducting <br />` Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteretion _Repair <br />Show Number (#) of fixtures <br />Toilet <br />' Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <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 compl <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 conslruction <br />That I am au ed 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 />� <br />, ,, ��,�'�L-t�' ��./ �id' _ ��- , ! <br />Owner uthor' e Agent Signature Date (Revised 9/2014) `f `� <br />� <br />