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• s <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 />f E ADDRESS: PROPERTY TAX # PERMIT # <br />� <br />_�--- �- �-�, w' � �--r,,� � z ,�..�� . r/� 1 j �C��, - ��f <br />GAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />'VNER ��r � � �)�,: ��,�� Phone/E-mail `'i �.�� � � � � - ,5-��-� 4� � <br />jress .� a-a� l �,J t. �rh o �� %��/ 2., City/State/ZiP != V 2 �� {'�" �'� ���� :,�� 1 <br />'PUCANT: _ Owner _ Owner's Agent � Contractor _ Contractor�S A92flt _ T@(18f1t (must provide a letler of consent hom lhe owner to do work in the space) <br />)NTRACTOR j���� ��u:� ��b � 1-�Zu:�' �r�t� ��4' AC, L& I Lic. #����'���H�'Nf�.�', � 1E� l. 3 COE Bus. Lic. # <br />iress , . �} � � �; ; �-� ti �L � , �i I-� Phone/Email i } ,��� � j „Z,� " �) C: � � j <br />PhonelE-mail � "�� % �� �� � �'�' ��� � �` <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � �, ��C%� %���f� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric Other_ � <br />� — <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <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) : <br />r ( � <br />�i,,: \�.l Z�'� Y'1G,'� i.l � �v'�(\C�.0 L � �.i� Z C-t('t C. �L+.r'C � C< (�\ r�1'�l�l C� ��`� � <br />i <br />rn����+� ��v.L�l.Jvrl�.., <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 Show Number (#) of fixtures <br />j � A/C - air handling units � Toilet <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 />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Lavatory (wash <br />Shower <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/ba <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />,� <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 nol presume to give authority to violate or cancel the provision of any olher state or local law regulating consiruclion <br />That I am authorized by the owner of lhis property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />i <br />1ti.,u.� ,�,��v :� " � � ( 3 <br />O e,/Authorized Agent Signature Date <br />tJ <br />(Revised 6/2012) <br />