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� • • <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 # PE�IT # y� �j+� '�j <br />: �' % �' !� C f l ., i.° t' 41 � �Y0 ,�" <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />ER <br />APPLICANT: _ Owner _ Owner's Agent <br />CONTRACTOR J�Hn i��„-1.��, 3Jr Cr <br />Address `?,2 `y _S �t c� i: •��'� (e �+1 r <br />�' ly P c <br />Contractor <br />� F1 itl. <br />Phone/E-mail <br />City/State/Zip <br />COIltf8Cl0f S/�g211t _ T2f1211� (must provide a le�ler of consent from the owner to do work in the space) <br />L& I Lic. # COE Bus. Lic. # <br />M�r�r . <br />{f �.� 7°� Phone/Email � , C ;G/ / 7` ,��-�, <br />CO AC FOR PERMIT <br />�_� <br />Phone/E-mail <br />Bu1LDING PERMIT APPLICATION CONTRACT PRICE OF WORK �� �.S--f-� r� <br />Existing Use of Building �u / j-, f-�'im r(e,, HEAT SOURCE: <br />Proposed Use of Building S q�.e_--� , <br />Building type: _ Single Family _ Duplex _Townho�u/se ulti-Family _ Commercial <br />Type of project: New Addition Remodel Y Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back1 : <br />/�t�'f�IClCt �._ F�J on hR�� w�z �l <br />MECHANICAL PERM/T APPL/CAT/ON <br />Type 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 />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Ducting <br />Other <br />1 SUPPRESSION SYSTEM <br />Number of Heads <br />olition Chanqe of Use <br />PLUMB/NG PERMIT APPLICATION <br />of Project: _New _Addn �Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <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 goveming this type of work will be complied <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 authorized by the owner of lhis property to perform the work (or which application is made and I comply wilh lhe State Contractors Law 18.27 RCW and 296.200A WAC. � <br />_ / � �y <br />��� C%� - � �-� 3 - � <br />OwnerlAuthorized Ag� Signature Date (Revised 6/2012) <br />