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� <br />� ERMIT APPLICATIO <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 />r�^ f°I• SV�I <br />LEGAL for new construction: Short Plat/subdivision <br />OWNER � ''J � � S�I V� �i� <br />AddressZ� � l(/ � � � 1 � �� <br />PLICANT: _ Owner <br />NTRACTOR � L <br />la <br />BUSINESS NAME <br />Owner's Agent �Contractor <br />� ��� ! v i ri <br />BUILDING PERMIT APPLICATION <br />PROPERTY TAX q <br />PERMIT # <br />r��i rt�/� 1- C� � <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail � � — � ��� V i �� <br />City/State/Zip��Q�l��-(� , w� / U 2� 3 <br />COf1tf2CtOf�S A9B�t _ TB(laflt (must provide a letter of consent from the owner to do work in the space) <br />State Lic. #�jL�VJ � /�'fj Yj(Q � Cit <br />� tij Q Lf� Phone/Email Z� �( <br />CONTACT OR PERMIT <br />l� i 1��l V�ti��� z <br />Phone/E-mail 2���� � I � � <br />CONTRACT PRICE OF WORK O j <br />Bus. Lic. # i7 <br />� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building 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 ihe back) : <br />�'D — 8'0 � mc� c.� �►.�,v.�.e cs �t -f— <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn '�Alteration _Repair <br />Show Number # of fixtures <br />A/C – air handlin units <br />Forced air s stems <br />Gas i in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes dr er <br />Ran e hood <br />Exhaustfan <br />Heat um <br />Unit heater <br />Boiler <br />Hetrigeration <br />Woodstove <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration <br />Show Number (#J of fixtures <br />Toilet <br />Bathtub <br />Lavator wash basin <br />Shower <br />Kitchen sink & dis os <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink service/bar/mo <br />Backflow reventer i <br />Urinal <br />Drinkin Fountain <br />Floor drain <br />Grease tra <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />Repair <br />al <br />side b <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 comp <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 authoriFed by the 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 />01�11�1 � <br />wner thoriz gent Sign ur Date (Aevised 4/2015) <br />