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� <br />• <br />��RIVIIT APPLICATIOIV <br />BUILDIIVG/tVIE�I�AfVICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ITE ADDRESS: <br />:J-�l i�; S l'i'1 SC'EI L�J��c � �:'��t-�)_� <br />EGAL for new construction: Short Plat/subdivision <br />WNER �f ) l l J� IT ��t'1.L 1` <br />� � <br />idress � '� � c:� C ,� �,_'`��_ <br />PPLICANT: _ Owner _ Owner's Agent _ Contractor <br />ONTRACTOR —'�' <br />�dress "'��� <br />PROPERTY TAX # <br />Lot No. <br />P <br />(attach copy of long legal description) <br />Phone/E-mail - - � "'; �-- <br />City/State/Zip �1 �J L �j f � L' � ��' � �` � f �� <br />Contractor's Agent �TB�B�t (must provide a letter of consent from Ihe owner to do work in lhe space) <br />State Lic. # City Bus. Lic. # <br />C -�=� /� j L' ���� �- ��+� r � l � � `tf� <br />Phone/Email <br />�R PERMIT ^ <br />�� �� L L�� Ls' �-i� � I� <br />i � Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �'—' <br />Existing Use of Building � HEAT SOURCE: <br />Proposed Use of B ilding "� ���'� �� �� �v�� � � � � Gas Electric_ other_ <br />Building type: �/ Single Family _ Duplex _Townho se _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additiona/ space provided on the back) : <br />�1i °€fR'�' C.�_riS1,-Q O C�-SV� 2/� 5 � �� � � �� �'e.�-S <br />O O <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures 5how Number (#) of fixtures <br />A/C - air handling units i Toilet <br />; Forced air systems , Bathtub <br />Gas piping <br />basin <br />; Water heater � Shower <br />Gas fireplace Kitchen sink & disposal <br />j Gas range i Dishwasher <br />Clothes dryer i Clothes washer <br />Range hood Water heater <br />� Exhaust fan Sink (service/bar/mop/etc.) <br />i Heat pump ; Backflow preventer <br />; Unit heater Urinal <br />�� Boiler i Drinking Fountain <br />': Refrigeration j Floor drain <br />Woodstove Grease trap <br />Ducting ' Roof drains <br />Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM � Other: <br />Number of Heads � 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 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 this property to perform the work for which application is made and I comply with the State Coniracrors Law 18.27 RCW and 296200A WAC. � <br />1 <br />� <br />�. /:�1�5�� > G��� C. �- Z�-� - 2 �� �`f <br />Owner/Authorized Agent Signature Date <br />(Revised 3/2013) , <br />