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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 />SITE ADDRESS: � `,, �y : � IPROPERTY TAx # <br />�,c.��; fi��.,c' . <br /># <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />�} � � Su.nGrk�(/6 ��'K+� <br />OWNER (� �� �� � L C , c=L;�'! /-t'�5'�'E' Phone/E-mail 2 JE— 1 j�-%%% j <br />Address � � � �� -{ � City/State/Zip _� r'l •✓ �� ; r'l ' ` �^ � ,�.' ! l � z` L <br />t- <br />APPLICANT: �,Owner � Owner's Agent _ Contractor _ Contractor'S A92f1Y _ T0f12f1i (must provide a Ietter of consent from the owner to do work in the space) <br />CONTRACTOR l���V ��'� State Lic. # City Bus. Lic. # <br />IPhone/Email <br />ONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building �i ; �JI:Y`� ` HEAT SOURCE: <br />Proposed Use of Buildinq --� � ��Z Gas_ Electric_ Other_ <br />Building type: �� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler Demolition Change of Use (� �"�' �j ' <br />DESCRIPTION OF WORK (additional space provided on the back) : _ <br />`�. .i_ �� �; � p �> i <br />'r.���v��i �.!'fi -� ��;: � �.. � �'j ��s_1�� :� �/ � � L <br />� -� 3� c' c.: ;;�� < � . � � ' � � r c.��' 'l,� �'r "! <br />� l J �>r S c� � �.�� �� � �; n� . I ^cw,�rt �'� -- -�h' .3 : � �'- a't C� % ; L � <br />p�2��, Tcc[�4s� AdDi���N�rc. Pe�rrc+s �,,ctQ�c�.�b a.,r�-�vc�` �S� CwrMe�.crn�. P�.s�-� E��i��r� <br />MECHANICAL PERMIT APPLICATIOR �' , �� PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C – air handling units <br />; Forced air systems <br />j Gas piping <br />'I Water heater <br />Gas fireplace <br />� Gas range <br />i Clothes dryer <br />Exhaust fan <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />j Lavatory (wash basin) <br />� Shower <br />j Kitchen sink & disposal <br />i Dishwasher <br />Clothes washer <br />Water heater <br />� Sink (ser��ice/bar/mop/etc.) <br />! Backflow preventer <br />i Urinal <br />Drinking Fountain <br />Floor drain <br />i Grease trap <br />j Roof drains <br />I Medical Gas <br />I Other: <br />� Other: <br />I hereby cerlify that I have read and examined ihis 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 ' am authorized by ihe owner of this property to periorm the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br />, Y ' , tG � <br />OwnerlAuthorized Agent Signature Date (Revised 3/2013) <br />