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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 www.everettwa.org <br />SITE ADDRESS: <br />���,� � �'� �� �t-m c,ti��e. C�.l,�- . <br />LEGAL for new construction: Short PlaUsubdivision <br />OWNER .,�i'�✓e��� � �.��!'I�J <br />Address � b �� ���� Y� C�j,--e <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ <br />CONTRACTOR �--�n`� � L�� ��'fi'"`� `�`� <br />ress <br />j(`t,i,�'�C� �--v�r7� Pl l,� (1 5'' "" 1' <br />BUILDING PERMIT APPLICATION <br />PROPERTY TAX q PERMIT # <br />�� r;�c�'�►("l��i���t�'�'C.��C��-' �r�a�� D <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail � - j2� �T -:} }}�— �u��p��L,.Frvy1���. <br />City/State/Zip ri �% �"..L,r � ��l.i �t C� �.a'% 1 <br />COf1tf8CtOf�S ACJeflf _ T2f18f1i (must provide a letter of consent from the owner lo do work in the space) <br />state uo. # l.,i; ���;(���-� �1��'�1_c�cy Bus. u�. # <br />Phone/Email ��C� — 1 � � 'ty.i' � � <br />CONTACT FOR PERMIT <br />,�;--� �}-c�,rl t' S <br />��— <br />Phone/E-mail ,�'� � ,�,`j � � �"�"� <br />CONTRACT PRICE OF WORK <br />Existing Use of Building {'"�� lt: �l J�''L� <br />Proposed Use of Building ��il.•U f't 5�P Gas_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition � Remodel _ Repair _ T.I. _ Sign _Sprinkler _Der <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />��C..t,'if�1CC��� ��'�3VV� �i'1 �Z'�.;r� i.-'� (�..y � 1 1�� l�l.� �.tiJ C7 11:1`\ 111 ii'� : <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />j A/C — air handling units <br />1 Forced air systems <br />� Gas piping <br />Water heater <br />Gas fireplace <br />j Gas range <br />Clothes dryer <br />Range hood <br />; Exhaust fan <br />j Heat pump <br />; Unit heater <br />� Boiler <br />Ketrigeration <br />Woodstove <br />SPRINKLER / SUPPR <br />Number of Heads <br />ON SYSTEM <br />HEAT SOURCE: <br />� Electric Other_ <br />olition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />Lavatory (wash basin) <br />I Shower <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <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 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 peRorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�v <br />��.., ;�,�.,� , � b , -,�--. 5 - � (� -- �.3 <br />O er/ uthorized gent ' nature Date (Revised 3/2013) <br />