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�ERMIT APPL.ICATI� <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 A���/DDRESS: , i,r�` /; � / PROPERTY TAX t# PE IT #r <br />/' '- / �-,i %(�� /""! - f� i`__ {-�r /• !�;� �'i/,"? �L�'�u �� _'r�l �'- �c�• r7,�� / ( �I <br />LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />OWNER GL v�/��� Q(/��/��I,� �T Q�/ �` Phone/E-maii iz,�G �J � G L_ Z <br />Address �/�/ � �Q��r �(�� � City/State/Zip �v���� ��� <br />T: 1/ Owner _ Owner's Agent _ Contractor <br />CONTRACTOR <br />ress <br />BUILDING PERMIT APPLICATION <br />-D <br />COf1tf8CtOf�S A9211t _ Tef7811Y (must provide a letter of consent from the owner to do work in the space) <br />Lic. # <br />Phone/Email <br />Bus. Lic. # <br />ONTACT FOR PERMIT y� I � n ���"� " <br />/\ /� /'✓ <br />ione/E-mail �ZSJ.j D� i.�'��} /�d/(�/�����f%/l• !3/.��� <br />ON"fRACT PRICE OF WORK ; S��: �'Z, <br />Existing Use of Building HEAT SOURC <br />Proposed Use of Building Gas Electric � <br />Building type: _ Single Family Duplex _Townhou�e :���crfi� — Commercial — — <br />Type of project: _ New Addit oi n' Remodel `�f Repair _ T.I. _ Sign _Sprinkler _Demolition Char <br />DESCRIPTION OF W,�O K(additionaf space provided on the back): <br />.�°�7`�f�J��E � �` ��/-�/'% c�.�✓ �} �r �-��✓,i�/C :a <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Aiteration _Repair <br />Show Number (#) of fixfures <br />A/C – air handling units <br />� Forced air systems <br />( Gas piping <br />� Water heater <br />� Gas fireplace <br />Gas ranae <br />�iotnes aryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Refrigeration <br />Woodstove <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />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 />Shower <br />Kitchen sink & dispos <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mo� <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 ceriify that I have read and examined this application and know the same to be true and correct. All provisions of Iaws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does nof presume ta 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 />Owner/Aut,F�ri�d Agent Signature <br />Date <br />1 l �, <br />(Revised 3/2013) <br />