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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 />ADDR SS: <br />i�,� � �1 s r s � <br />PROPERTY TAX ►# <br />PERMIT # <br />L for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER <br />Phone/E-mail <br />Address � I City/State/Zip <br />APPLICANT: _ Owner _ Owner�5 A90fll _ COflti'aCiOf _ COI1tf8CtOf�S ACJ2Ilt _ T2f12f1f (must provide a Ietter of consent from the owner to do work in the space) <br />CONTRACTOR �'�=J )ZL�'� l r+ ����j�/���-_ tate Lic. #��5 L�,.7'c%rJ",� � �l City Bus. Lic. # v� <br />Address �yj�� � 2 �j/ _3 ��%�L- �%"-'�� W�''�" / (,L���- Phone/Email f�Z �7 ��-3 J %y 7 <br />--•---•-� --------- �---�--- ----•---. . <br />� L��` �n,�/ n!r.0 (i <br />Phone/E-mail �ZS y2- 2 �iG'� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �� <br />Existing Use of Buildir�g HEAT SOURCE: <br />Proposed Use of B Iding Gas Electric Other <br />Building type: �ingle Family _ Duplex _Townhou e_ 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) : <br />� V�j G�l �,C �' C.�i�/�j (` 2/'��' / C'`�i `� �L� � L.✓G7/��� <br />MECHANICAL PERM�T APPLICATION <br />Type of Project: _New _Addn v Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />�—� Forced air systems <br />Gas piping <br />' Water heater <br />j Gas fireplace <br />i Gas range <br />� Clothes dryer <br />( Range hood <br />Exhaust fan <br />Heat pump <br />( Unit heater <br />, Boiler <br />; Woodstove <br />! Ducting <br />� Other <br />PRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />; Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />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 the owner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�% <br />� , � -� y� l� �� i � <br />, <br />Owner/Authorize gent Signature Date (Revised 3/2013) <br />