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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 vwvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />iITE ADDRESS• PROPERTY TAX # P/����� r� , <br />: �t.: �' e � � � v �-L% �r. f ` ��" � <br />.EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />�WNER �,r���>, . �, - r z;.,� ;> �_?s-� . iiu .•-� �,;-� ls-.,, �?hone/E-mail Z,� z` j C 4'>�� i: t:; <br />>ddress 1'� �-� L c�- �,� � �� u Y- �.+.� � � yi � � City/State/Zip �� �f�� � Y v�J '� � , "Lc; L <br />4PPLICANT: _ Owner _ Owner's Agent .y Contractor _ Contracror'S A9Bf1L _ TBfl2flt (must provide a letter of consent from the owner to do work in lhe space) <br />�ONTRACTOR �'� � ��� ��- �, C t c%'-°=- L& I Lic. #��sc �°> �� i? � COE Bus. Lic. # E'? Z �' `i <br />-i-� L,'x, � _,�,,.� ,y ;,�.�. ��y•.c>�s �._. Phone/Email � � � -7 � � (,,".'n:iC� <br />4ddress � 1 �� �� ' i � l:� � � i ( � <br />T�ANT BUSINESS AME CONTACT FOR PERMIT ` '� � r, t'1..� <.��,I h� a u.;�:-� ,,,•• ✓1 -� <br />h c � �� �i � *- L � r ` � �- � t � �Z i.� � `�-�'.'��� , � Z� � - •, � � �n � C� <. <br />•..�r�. k- � r`_ � Phone/E-mail '�Z S' � 1� �-." t.l' <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � S�'�� 1(:= t. <br />Existing Use of Building y` 1�1�-� ��'`�� ' �`l HEAT SOURCE: <br />� _ '' �/ Gas � Electric Other <br />Proposed Use of Building � �i �- �� '`��"� � 1- <br />Building type: _ Single Family _ Duplex _Townhouse � Multi-Family _ Commercial <br />Type of project: _ New _ Addition �' Remodel _ Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />Change of Use <br />j7 '7 �� t... L ` i. -� �; • 0 �' 1r1 i' ^ , '�. ! . r `'�J , � �- I <br />1`' � � L�+'� r'_ r_% ti -� t C S I.`� i. (� 9� , .•- <br />r.�;_i i t��:>: ,� L�. `� f� c� �: -'\ L.� . <br />MECHANICAL PERMIT APPLICATION <br />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 d er <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />—� Boiler <br />Refrigeration <br />Woodstove <br />� Ductin <br />Other <br />SPRINKLER / SUPPRESSION <br />� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />Lavatory (wash basin) <br />� Shower <br />Kitchen sink & disposal <br />�Clothes washer <br />` Water heater <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 ceAify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and ordinances goveming 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 />Thal I am authorized by lhe owner of this propeAy to perform the work for which application is made and I comply wilh the State Contractors Law 18.27 RCW and 296200A WAC. <br />7 <br />� .�, ' j , � <br />�~-�; �/"! . �/=—.____ �� �� � c: ��S <br />,.-Owner/Authorized Agent Signature Date (Revised 6/2012) <br />