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r <br />� � <br />PERMIT APPLICATION <br />BUILDING/ME�HANICAL/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 �Dpr2 ( �,-�j.-�'� � S� IPl!/( /i� �A�l!/ 5v`f�z��Y� I �1 � � �i 02�� ` <br />�..� —� / <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER ��T�Q�-Y ��1 A���� Phone/E-mail'"1�' 2��' ['S C�� <br />PPLICANT: <br />ONTRACTOR <br />idress 1 �c <br />3 �- <br />_ Owner _ <br />��� <br />� <br />=SS NAME <br />Sl - S£� <br />�r, <br />�� <br />Owner�S A98flt � COI1ff8CtOf _ COf1lf2ClOf�S ACJEf1Y _ TEflBflt (must provide a letter of consent from the owner to do work in lhe space) <br />BUILDING PERMIT APPLICATION <br />. IState Lic. <br />Bus. Lic. <br />�Phone/Email�'(�j ��( b - �(� � .�- _ <br />ONTACT FOR PERMIT <br />�one/E-mail L.kJ�V' v` �1 `(��I i�� � l��- l <br />�NTRACT PRICE OF WORK �p �� L%_J_LI � U`� <br />Existing Use of Building ' HEAT SOURCE: <br />Proposed Use of Building _ � Gas_ Electric_ Other_ <br />Building type: Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial ,� <br />Type of projec� New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition �Change of Use <br />DESCRIPTION OF WORK (addition space provided on the back) : <br />�� � i�C� t� S e� Y�S�. ��. <br />�' � I �- In1 � ►� �1,Q����- ��� � <br />C-�as � � � -�Y� P ��- �� <br />MECHAN L PERMIT /J►PPLICATION I�- PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />i A/C - air handling units <br />I For�ed air systems <br />X i Gas piping_J <br />—�.� i r eater <br />� Gas fireplace <br />i Gas range <br />Clothes dryer <br />Range hood <br />; Exhaust fan <br />j Heat pump <br />; Unit heater <br />; Refrigeration <br />; Woodstove <br />Ducting <br />' Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />/1 Number of Heads <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />j Lavatory (wash basin) <br />� Shower <br />� Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />; Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />� Drinking Fountain <br />Floor drain <br />Grease trap <br />; Roof drains <br />i Medical Gas <br />Other: <br />Other: <br />I hereby certif� that 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 wheth r specif ed 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 autho 'z d by own of th� property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />i , � �� <br />i � <br />nature Date (Revised 3/2013) <br />