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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: �,, � PROPERTY TAX # P�f,t ��#� �' f,� � <br />-� � i �� �� 5 L1� Cl/rtP� ,�`7 <br />for new construction: ShoR PlaUsubdivision Lot No. (attach copy of long legal description) <br />t ��en.��v �an, �tf 4V- Phone/E-mail y�,� %% 3j�2 tN u�...� F: a/ o <br />j �j }"� 3� '(,�,�' City/State/Zip k�/rf�� i�t/=� �%�2Gf <br />ANT: _ Owner _ Owner's Agent �` Contractor _ Contractor's Agent _ Tenant (must provicie a �etter ot consenc srom u,e owner to do work in me space) <br />�i /u�� �� <br />� <br />� <br />L& I Lic. # iti'�.1-�L ��' yti�t C COE Bus. Lic. # <br />�� / PhonelEmail ��Ij' SUc'' y�%7/��,(� c�,r:lcr.�;�. <br />�c,>,�"� L7i(I�,°/ �/LS"i Ors '�87� ,JE�J�i��-;��,•�c�,:,�.«,.. <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��7.�y �y <br />Existing Use of Building �c; �(�„cc HEAT SOURCE: <br />Proposed Use of Building Sa�„P <br />Buitding type: 1� Single Family _ Duplex Townhouse _ Multi-Family _ Commerciai <br />Type of project: New Addition Remodel � Repair _ T.I. _ Sign �Sprinkie <br />DESCRIPTION OF WORK (addrtional space provided on the back) : <br />�Pm�.,00L° l%—l� Qn� rG��/.ce S�cf �.� /f 21%��. �t.� f1�;,:.1_ <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handlin units <br />I Forced air systems <br />Water heater <br />Gas fireplace <br />as range <br />CI es dryer <br />Range ood <br />Exhaustf <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />ISUPPRESS <br />Number of Heads <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of P oject: _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 />C�othes washer <br />Water heater <br />ink (servicelbar/mop/etc.) <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 cotrect. All provisions of laws and ordinances goveming this type of work will be complied <br />with whether specified herein or not. The granting of a pertnit dces not presume to give aWhority to violate or cancel the provision of any other state or local law r�egulating construction <br />That I am authorized by the owner of this property to perform the work for which application is made and I compty with the Slate Contradors Law 18.27 RCW and 296200A WAC. <br />,�/ <, .—„" "�_ _--. / ��� <br />%�"� .��r; �/ �`'�%/2 <br />O�r/Authorized Agent Signature Date (Revised 6/2012) <br />