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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 />SITE ADDRESS: �,Z 3 ` � ' 1G��� <br />v <br />'ERTY TAX N P�:a,MIT # <br />`�39 17 �4 Q 1500 K i� f <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />ER <br />add�ess lP.�G�� .MK12l,tJ�6 D(Q.��1F- �C...1� <br />APPLICANT: �Owner _ Owner's Agent _ Contractor <br />CONTRACTOR � �.S Gdl.,� ST�RUC`�(d,U <br />Address �y {� �l � Y�-$, � �,J�/�� <br />� � k���. c �r R.a P�►��'rc <br />Phone/E-mail 'L1�6 "S/() ^ZrjYB M�4r=Kle <br />0 <br />ICity/State/Zip ,t�Ifq12Y5UlC�E c.Js4 <br />COfIff8CY0f�S Ag@flf _ TBflaflf (must provide a letter of consent from the owner to do work in the space) <br />State Lic. # �5eaG ��rDT� c�cy Bus. ���. # <br />Phone/Email Z06-5�0 - ZSY�j <br />CONTACT FOR PERMIT Nt(A�Q, P.,�EtC( �� <br />zo6 - sro z s��8 <br />Phone/E-mail /tq /4QtCN2,,,4C� Gt1E-S —C,d►J$j'Ktf�jG,U [d�L <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK :'�, t'�(� <br />Existing Use of Building �,LA[G144. ��LCrc HEAT SOURCE: <br />Proposed Use of Building �Es'OIGI�..., GJtT'lG �G Gas� Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family �ommercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): �{,v�Ud(,(J J�'�.p� ���„�E��- �� <br />�11F G�� �"K�� �� 6 a %�".M,d Cl M� pF- l�,�'j�U�-- 5TI2U7`CJ�4{.. C,v � dJ6 C�t1 �•(.{i S <br />� � 5 ����t1G . � <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />� Forced air systems <br />i Gas piping <br />j Water heater <br />Gas fireplace <br />I Gas range <br />Clothes dryer <br />Range hood <br />I Exhaust fan <br />Unit heater <br />Boiler <br />; Kerrigeration <br />I Woodstove <br />Ducting <br />I Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />j 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 nreventer <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby ceRify 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 />wilh whether specified herein or n. 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 author' by t o r this propeRy to peRorm the work for which application is made and I comply wiih the State Contractors Law 18.27 RCW and 296.200A WAC. <br />l /z <br />06 � w( 3 <br />Owner/Authorized Agent Signature Date <br />(Revised 3/2013) <br />e d�c� <br />