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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 />SITE ADDRESS: PROPERTY TAX # PE MIT <br />�;�z ��,�-� ��� 5 � �v�, �� i t" �� ��I �(f� _ <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />� /-' <br />OWNER �j �� �,� � Phone/E-mail Z� - � � � ' �U � � <br />Address J'� G ��i� ��c� �� City/State/Zip (�t'� �� � L� 1 v S <br />CANT: Owner <br />CONTRACTOR <br />�� C <br />_ Owner's Agent � Contractor _ Contractor�S A9@flI _ T2�2f1i (must provide a letter of consent from lhe owner to do work in the space) <br />,���i �(%L �Q�'%�� �� L State Lic. # 1`--2vLt%( v�Z� 7��City Bus. Lic. # �' —�j 2 � <br />���/' S� , ' (l %l �l! Ld'L��fiLc Phone/Email � - �7��- �% � <br />CONTACT FOR PERMIT <br />Phone/E-mail �U� � � ���'7� � <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building Ga <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel _ Repair _ T.I. _ Sign _Sprinkler _C <br />DESCRIPTIOfd OF WORK (additional space provided on the back) : <br />� E-12u D F lZ���- � J yr r� i'- �vv� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />A/C - air handling units <br />( Forced air systems <br />Gas piping <br />' Water heater <br />I Gas fireplace <br />I Gas range <br />� Clothes dryer <br />� Range hood <br />� Exhaust fan � <br />Heat pump <br />Boiler <br />HEAT SOURCE: <br />Electric Other <br />emolition_Change of Use <br />%� :S % f%"l� %i%G l� f�G 0� <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />; Toilet <br />i Bathtub <br />I Lavatorv (wash basin) <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 />� netngeration � Floor drain <br />� Woodstove � Grease trap <br />i Ducting � Roof drains <br />Other � Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM j Other: <br />Number of Heads � Other: <br />I hereby ceRify that I have r a and examined th a ication d k ow 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 her n r nol. The grant' f a permi does t 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 th ner of is pro y to perfor the rk for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized gent Signature Date (Revised 3/2013) <br />