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• <br />� <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 />ITE ADDRESS: � � PROPERTY TAX # P MI <br />�� �: �u �'� ,t�cr�r,� •�c���i �vcvuti�c �j ��lo� -D�- <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />WNER IY� /1 �l< 1�1G��,t=+,�/JSU� Phone/E-mail � �5 �5.� - �: � c .g <br />idress Cp/ �; !� C% %� / City/State/zip � �/ �✓�2 / % �<-'A 9.� � �J l <br />PPLICANT: ! Owner _ Owner's Agent _ Contractor _ Contractor'S Ag2fll _ TBf12f1Y (must provide a lelter of consent from the owner to do work in the space) <br />ONTRACTOR � j: <br />dress 1 f� JY�L° %�)' ,p-%C� U� <br />C:�( _�: ,�L L��c.c: v'' � t C'7 <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />City Bus. Lic. # <br />CONTACT FOR PERMIT �� �� ��1 _�L��C� <br />C� �'�, C� ��? -'��� �_:'� 7� <br />Phone/E-mail ��n(Ll�NiiSd��J��:�J.i(����'�;t-t�'�iT1F�L�C.U� <br />CONTRACT PRICE OF WORK ��.LY1 �� " <br />Existing Use of Building '�C-�>>Y ��t <<' <br />Proposed Use of Building c' %� `f� L <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family <br />Type of project: New _ Addition _ Remodel _ Repair _ T.I. _ <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />1��1>��� �?�'�;�__��1�';�� {\�� Z��� <br />MECHANICAL PERMIT APPLICATION <br />Type 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 firepiace <br />j Gas range <br />i Clothes dryer <br />Range hood <br />; Exhaust fan <br />Heat pump <br />i Unit heater <br />Boiler <br />Woodstove <br />Ducting <br />j Other � v' �� <br />NKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />Gas �;� Electric Other <br />Commercial <br />Sprinkler Demolition_Change of Use <br />PLUMBING PERMIT APPLIC�.I,TION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />i Toilet <br />! Bathtub <br />i Lavatory (wash basin) <br />i Shower <br />; Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />; Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />j Roof drains <br />i Medical Gas <br />I Other: <br />' Other: <br />I hereby ceAify that I have read and examined this application and know the same to be lrue 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 the owner of this propeRy to peRorm 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 />�'~.._ l.�— �1 <br />Owner/Auth rize a u Date (Revised 3/2013) <br />