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� � <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 />SITE ADDRESS: , ` PROPERTY TAX # F�R IT #r� � <br />� � �-� � �,(-'" �' � 7"L7C' � c'. 1 � ��) 't" — (��-) .� <br />— � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER � �,," f�� � , � -� ,-, ��!j', �. � r � � `� Phone/E-mail � �� C1(�� c,� �, !_, <br />� �_ � "1. ` � <br />Address � � � � }�'C ���•�-: , � � R( � City/State/Zip i, r q �t`C �'� � � �,�,' �� � ,'�� .%' '� � <br />APPLICANT: _ Owner _ Owner's Agent � Contractor _ Contractor�5 A90fli _ TBIl811t (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR �- �� C-�h�� %:�, �� T �'�`� L& I Lic. #,� ` j� (.'� n�:'; �, y`� COE Bus. Lic. # <br />Address �,,' � (`�i_� J�Cr' l �,`/ i�,- /�� .�-� i'�i� l ( ! c t,. � Phone/Email '7 ��� �� �/ — %�--> ; �� <br />Phone/E-mail , -_�, `� � ._� �- <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building Gas <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Dem <br />DESCRlPTIOM nF V�QR!( (additional space providad on t,he back) : <br />i :-, �'r/ - -/ <br />, �C�� <br />�riSL'C-�� <br />HEAT SOURCE: <br />Electric i <br />Chanqe of Use <br />�'C !� ('��'� 1` � Y7 '-�— S; (' l r �� � ;(.� � t�! (J' �''GC ! S � <br />MECHANIC L PERMIT APPLTGATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show Number (#) of fixtures <br />A/C — air handling units Toilet <br />� Forced air systems Bathtub <br />i Gas piping i Lavatory (wash basin) <br />Water heater Shower <br />� Gas fireplace Kitchen sink & disposal <br />Gas range Dishwasher <br />Clothes dryer j Clothes washer <br />Range hood � Water heater <br />Exhaust fan Sink (service/bar/mop/etc.) <br />Heat pump � Backflow preventer <br />� Unit heater ! Urinal <br />Boiler j Drinking Fountain <br />; Refrigeration � Floor drain <br />Woodstove ; Grease trap <br />Ducting Roof drains <br />� Other Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />� Number of Heads j Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correcl. All provisions ot 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 />-- • _ <br />/ , , _.__----_ <br />__ <br />i / / <br />__. ,�, � <br />\—fJy� �=' _ �_ 7 / G�'e . <br />wne /Authorized AgeqL ignature Date (Revised 6/2012) <br />