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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: PROPERTY TAX # P.ERMIT # j /l <br />�1L`:+L��(.Le` � - ) � � � I 1 � V L� � <br />LEGAL For new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER � ' i :7 � '�, � Phone/E-mail �j < <'i ' �,�j� � j <br />Address J .� � ' ,J City/State/Zip � � ♦ � �, ' <br />APPLICANT: _ Owner _ Owner's Agent •" Contractor _ Contractor�S A98f11 _ TBflBflt (mustprovidealetterofconsenlBomtheawnertodoworkinthespace) <br />CONTRACTOR �, ' ( � —, ; � L & I Lic. # ` �_ �,� I ` - " • COE Bus. Lic. # <br />p � , <br />Address_ ��( ..7..� c (�� �i;.-y ���/ /l:,�l.,.�'i�� �%i�,��_;! Phone/Email <br />Phone/E-mail � � �� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building Gas <br />Building type: ,� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New _ Addition _ Remodei _ Repair _ T.I. _ Sign _Sprinkler _Dem� <br />DESCRIPTION OF WORK (additional space provided on the back) : �< <� �, �1 �v �?u; iZvC <br />MECHANICAL PERMIT APPLICATION <br />Type of Project^ �New_Addn _Alteration _Repair <br />�iow Number (#J of fixtures <br />A/C — air handling units <br />� Forced air svstems <br />Water heater <br />Gas fireplace <br />Clothes dryer <br />Range hbod <br />Exhaust fam, <br />Heat pump � <br />Boiler <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />JG�'�vY��j <br />:� I �t' f -� <br />HEAT SOURCE: <br />hanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New _Addn _Alteration _Repair <br />�Show Number (#) of fi�ctures <br />I Toilet <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Sink (serv <br />Drinking Fou <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />nter <br />I hereby certify that I have read and examined this application and know Ihe same to be true and correct. All provisions of laws and ordinances goveming 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 lo violale or cancel lhe provision of any other state or Iocal law regulaling construction <br />That I am authorized by the owner of this property lo perform the work for which applicalion is made and I comply with the State Conlraclors Law 18.27 RCW and 296.200A WAC. <br />i �-� <br />t ��;,�,s, �l;.r�r����� ` l I -�-?r=, % �2 <br />gwner Authorized Agent Signature Date <br />(Revised 6/2012) <br />