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�ERMIT APPLICATI <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 ADDRES�' , PROPERTY TAX # PE MIT <br />� >- ,� , �� � � 0 �1 a =�� <br />�f't /,s''� 11�- �' .- ��r . �,C� i�J�J `�'�t��L, .J�'�! �',.> jcti <l . <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER G� v��G�� Q���/��� j� ����T ` Phone/E-mail �Z,�G �,f�, � L �, <br />Address ��Q / �Q� ✓� � �,�(�� C City/State/Zip �l����� � <br />APPLICANT: �Owner _ Owner�S AJ2f1I _ COI1tf2Ct01' _ COf1lf8CtOf�S A9@fll _ T0f1811t (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR <br />ress <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Bus. Lic. # <br />�Phone/Email <br />CONTACT FOR PERMIT��� �� ���" <br />Phone/E-mail lZ�JL�b�. 6✓T�c� �Ojt�/������9� d�� <br />CONTRACT PRICE OF WORK „S ,S�%�. ��D <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 project: _ New _ Addition Remodel -�Repair �/T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />��G's�F� l�l�f� t=G' ��14/�r G � r/F��P�`�Nf� �f�iv/'_�`��?�F" /'�%iNe�i� <br />i �. <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fizfures <br />� A/C - air handling units <br />� Forced air systems <br />� Gas pipina <br />SPRINKL <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 />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />� SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration �Repair <br />Show Number (#) of fixtures <br />! Toilet <br />! Bathtub <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dispos <br />Dishwasher <br />Clothes washer <br />Water heater <br />Backflow preventer <br />Urinal <br />Drinking Fountain <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 ut rized by the owner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. / <br />� � <br />��' ,��' j, � ' <br />� <br />OwnerlAuXi�`pri�d Agent Signature <br />Date <br />(Revised 3/2013) <br />