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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 />ADDRESS• /'r w.JNr !'�,`ll/ ��5��'�.:�� 55 <<��'t�'�- 5�:++j-9 PROPERTY TAX q <br />:7j �j�+� �Ve �(,�l'S�, CVef�+� Lt�<i <br />e <br />AL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />JER •� �S L �, (, c1 ,��: ��� Phone/E-mail � � _l - � � y � ��JU �.� <br />:ss 225 iC��+�.�ve � Sv.�t2 SriC) City/State/ZiP,�l�/t''v'�� �'u�.%� /�CJi�`� <br />LICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent � T211811t (must provide a letter of consent hom the owner to do work in the space) <br />\C:IUK /'i Gi'IC C rclYirS 1 <br />`%3 7.� � So -21 Z �'' St <br />H �I� ��,r ��1;�, J ��r �.. � � � <br />BUILDING PERMIT APPLICATION <br />State Lic. # KC�N��.r �K ����%��� City Bus. Lic. # UL�c'�%� <br />�%fy Phone/Email � 7 j' O% Z�' �/ � �l✓ <br />CONTACT FOR PERMIT J�� r j�•,� ��� <br />����, ey v.� �-��l�,,� � � + <br />L � UC✓J 7 hNr"C:/J�C �'J7eK, c.��;-» <br />Phone/E-mail / �"�i) �- ��+�j'.� -- _ <br />PRICE OF WORK <br />Existing Use of Building � <br />r <br />Proposed Use of Building L�Z✓��'�' r; �e��r ��Sc-�r, �iy <br />Building type: _ Single Family _ Duplex _Townhouse Multi-Family � Commercial <br />Type of project: New Addition _ Remodel _ Repair � T.I. _ Sign _Sprinkle <br />O OF WORK h b k� <br />� 3 ��. ,5 :1 `l: c�c. <br />HEAT SOURCE: <br />'� Electric_ Other <br />molition �C Change of Use <br />DESCRIPTI N (additional space provided on t e ac ). <br />���_y fa1 �� Gi/'i �J �L �� it»c� � 'fc.i h.^�`�r i.:tltr f�nu.�cr5, ��J'�wGi/y ,$ L.U,'�� .hc' i•✓�i�i�� ^rc� �• (_ry�, <br />Yl,.1w�i� � � �T �..�2:-�a� :�'7 c'�l��t'FC'lP:t'� �C'��•�S i✓%'l�ij '7/�t•. <br />�.E t�,r h�: ���,„� , s�,:�� s �� . Il �.� !r <br />�i^.,' . t"i- CY'.:tnr tiJc�:t� r•1�1CC .5�.5�'FI'h�. <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn �Alteration _Repair <br />Show Number (#) of fixtures <br />{ A/C - air handling units <br />i Forced air systems <br />I Gas piping <br />; Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Exhaust fan <br />Heat pump <br />Unit heater <br />�C Other� <br />SPRINKLER / SUPPR <br />Number of Heads <br />ON SYSTEM <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatorv (wash basin) <br />Shower <br />Kitchen sink � <br />Dishwasher <br />Clothes wash <br />Water heater <br />Sink (service� <br />Backflow pre� <br />Urinal <br />Drinking Fow <br />Floor drain <br />ttoot arams <br />Medical Gas <br />Other: <br />Other: <br />L <br />I hereby ceRify lhat I have read and examined this application and know the same to be lrue and correct. All provisions of laws and ordinances goveming ihis type of work will be compl <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 ihe Stale Conlraclors Law 1827 RCW and 296200A WAC. <br />Owner/Authorized Agent Signature Date (Revised 4/2015) � I <br />� <br />L- — <br />