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• <br />• <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 />ADDRESS: PROPERTY TAX tt PERMIT # <br />u i� ��!►-ST� c s,x,� z� ��-� I� 1� c'��o -- b 3C <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER ��{ arcl �i�-{� Gp,r �$—f" Phone/E-mail Z.c� 2 Z�, /303 <br />Addres`�o 5in'"�* /Zool�, /� �r: S li' CityfState/Zip �' ,� �,tJc� ��� <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�5 Ageni _ T@f18t11 (must provide a tetter of consent from the owner to do work in the space) <br />CONTRACTOR � j�,ef} I, o� f1 � Sn� L& I Lic. # p1 �'p 1� ����COE Bus. Lic. # <br />ress % <br />BUILDING PERMIT APPLICATION <br />C�s/�7ta/t�'S ! �(y PhonelEmail <br />)NTACT FOR PERMIT �1�� sj n no.�• <br />'ZG�6 � Z�o l..�p3 <br />one/E-mail ('Uy��/5� n�o'��"��i►'��AS' <br />)NTRACT PRICE OF WORK � S��•d� <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� � /��'�'I <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />Forced air svstems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />� Other <br />SPRINKLER / SUPPRESSION <br />Number of Heads <br />HEAT SOURCE: <br />Gas Electric Other <br />Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />; Bathtub <br />� Lavatory (wash basin) <br />j Shower <br />i Kitchen sink & disposal <br />! Dishwasher <br />j Clothes washer <br />i Water heater <br />; Sink (service/bar/mop/etc.) <br />Backflow pre <br />Urinal <br />Drinking Fou <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 perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�.a����./�"C.i��.!(/L�-�AA.f./ ,g�� <br />Owner/Authorized Agent Signature Date <br />(Revised 6/2012) <br />