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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 www.everettwa.org <br />ITE ADDRESS: PROPERTY TAX # P�RM T# <br />�3�/�! E� i�' - �>•�c,� ; �tr-�._ UC? _ � ?�C3�� �� (. �� 7-� � - <br />EGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />�WNER �l�tGi � L(�`f �/ Phone/E-mail <br />ddress � �c ��'� City/State/Zip � hf'j�G%T�'�� L� ��-r f�j�L J/ <br />�- C�l � /�-5�i G�z y <br />PPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�S A98fll _ TBfl2flt (must provide a lette� of conseN trom the owner lo do work in the space) <br />ONTRACTOR l C� u b� .�.11 State Lic. # �� �� �L �� `�S b't'�'Iz City Bus. Lic. # <br />, , <br />ddress ��J (� L � �Cr� � 131ct<< (���innccrC' Lc- ... %r�c''/C" Phone/Email �Gi ��t�� �� �i,� �� � �c��,,,.��c=j � i�c <br />FNGNT RIISINFSS NAME CONTACT FOR PERMIT <br />Phone/E-mail �1 L,�rp" S � - Z <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �,GC� `= <br />Existing Use of Building .�i •�,=� 1 C`�`7�""1i 1 U ��� f'`7L�" HEAT SOURCE: <br />Proposed Use of Building e3 �� 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) : � ,. ,�{-� ,-et-rrl rt�/C� �L!}�yc'�� <br />l�-�� y���, � f3 <br />�3r � n� /%Zz L �.� �ti. ,c'c . � l� - l:' �'vi � � a C�;c�� �. �, �,� tv,'�5 � �*'�''� <br />�� % � c ,-` �� �J r, L7;� n � l� �� r1 �� -l�d �F'1 vi� lYJ C��` �'�'� �1 J t�.IG�c���7 GiD41. �?�n ✓5 �7j✓rYl LJ; � <br />A�`' �,u7 I S U�.1 i I�t {-t ' '�,- <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show Num6er (#) of fixtures <br />, A/C — air handling units � Toilet <br />Forced air systems Bathtub <br />j Gas piping j Lavatory (wash basin) <br />; Water heater i Shower <br />Gas fireplace j Kitchen sink & disposal <br />j Gas range i Dishwasher <br />; Clothes dryer i Clothes washer <br />Range hood Water heater <br />Exhaust fan ; Sink (service/bar/mop/etc.) <br />� Heat pump ; Backflow preventer <br />i Unit heater Urinal <br />� Boiler � Drinking Fountain <br />; Refrigeration ; Floor drain <br />i Woodstove i Grease trap <br />Ducting Roof drains <br />� Other j Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM ! Other: j�; ;� �� ;��>.,� �- <br />Number of Heads � 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 authorized by lhe 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 />I �i <br />�- = -� /.� S- / <br />Ov,r e ut' riz d Agent Signature Date (Revised 3/2013) <br />