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� <br />i <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <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: � IPROPERTY TAX it I P�RMIT # <br />12.4��,�, 3c-{�.�:I� Ev�e�.�-rt �iw 2� �`�3�>�:•������ y�: 7,3�'c�'� I�l Z— L' "� <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />WNER � �ti��� v, T� s� Phone/E-mail <br />PPLICANT: _ Owner _ Owner's Agent � Contractor <br />ONTRACTOR �', ��' i�� C- �,;�(: <br />idress j-] �% �:� �-;J c'��� c�" �e-�' �\� N C <br />�City/State/Zip <br />Contractor�5 A90flt _ T@IlBflt (must provide a letler of consent from the owner �o do work in the space) <br />+ ,, <br />State Lic. # :� � �� � + � �iL� �' � City Bus. Lic. # <br />� t� / L C' Phone/Email Z�� �, `� ZNZ �-, i C. � <br />CONTACT FOR PERMIT <br />� �� � <br />� �y � ( � 7 �`�`J��� ll � ��-� uln�v� <br />�ral1L. Y"1�, � `�'� ., � f �r -�,'r �.GL� �� Phone/E-maii 2 ; h `i Z.Z �', 7 � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �GUG�' •C��= <br />Existing Use of Building L�:��2 F��=-. l.z �, <br />Proposed Use of Building <br />Building type: _ Single Family _ Duplex _Townhouse h Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkier <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />�:; -,���1�; c.il � ��� � � c�.c.<_ 5 c.�, ���,..�e�,-n..,U, U, � 1 r� S � 1 r�-t �<-� <br />��� � �, � <br />����� ) �� j <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />i Forced air systems <br />i Gas piping <br />� Water heater <br />j Gas fireplace <br />j Gas range <br />Clothes dryer <br />Range hood <br />—� Exhaust fan <br />� Heat pump <br />Unit heater <br />Boiler <br />� Refriaeration <br />� Ducting <br />j Other <br />PRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />HEAT SOURCE: <br />Gas Electric Other <br />Demolition Change of Use <br />C'�,;., �� �' r-c���t �-i c , v�t , , <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <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 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 periorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />��,,(��/ - il' 1- 3� 2c�3 <br />�t=�� 1 � � <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />