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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 vwvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: PROPERTY TAX # PERMIT # <br />i01 �th AYP. �✓, SSfE ��O ZgD�G30DyPG8'OG KISO�J-DO� <br />LEGAL for new construction: Short PlaUsubdivision <br />L� <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail <br />City/State/Zip <br />'LICANT: _ Owner _ Owner's Agent �Contractor _ Contractor�S AgOfIY _ TEIl21lY (must provide a letter of consent from the owner to do work in the space) <br />NTRACTOR PCtt�''l7)t t'�✓'C Pr0'�v��D✓1 L& I Lic. # Pi}T/�rFP� F COE Bus. Lic. #(/2HE�3�l <br />ress 2�d% 7� *h Ay E F�^e �/� "` l z Phone/Email 2s3 — R%�' ZZR 0 <br />JANT BUSINESS NAME CONTACT FOR PERMIT Dh„ Da� <br />��� <br />Phone/E-mail Vflit�'1 <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building 1Na'�'�G��� <br />Proposed Use of Building �� ��e%'�T� Gs <br />Building type: _ Single Family _ Duplex _Townhouse _°�lulti-Family �Commercial <br />Type of project: New Addition Remodel Repair l� T.I. _ Sign f�Sprinkler _C <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />vi��.G•LVv�I <br />2 000 , p� p <br />HEAT SOURCE: <br />Electric Other <br />molition Chanqe of Use <br />/�'Iodi(!,t''�q' S�or'MhIP►'' d'�dt�w� �i�' �'I�il�/ C�2N�►13'l�,q U^Rll �titd <br />�l � <br />o�'�es. <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn (/ Altera <br />Show Number (#) of fixtures <br />� A/C — air handlin <br />� Forced air syster <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Unit heater <br />n _Repair <br />u <br />Kerrigeration <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />S� � Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number !#) of fixtures <br />Bathtub <br />h basi <br />Shower <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/b <br />Backflow preve <br />Urinal <br />Drinking Fount� <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />ar/mo <br />nter <br />n <br />I hereby certify that I have read and examined this application and know the same to be true and correcL All provisions of laws and ordinances goveming lhis type of work will be compl'ied <br />wilh whelher specified herein or not. The granting of a permit does not presume to give authoniy to violate or cancel the provision of any other state or local law regulaling construclion <br />That I am authorize y th er of this property to perform the work forwhich application is made and I comply wilh the State Contractors Law 1627 RCW and 296200A WAC. <br />�1 � <br />O ner/Auth ' gent Signature Date (Revised 6/2012) <br />� ti�Z � <br />