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• <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />C1TY 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 />ITE ADDRESS: PROPERTY TAX # PERMIT # <br />bll lUlt� �71 �� �v�°�t"{-� \l�%�t Qi� �%71.i.� E�J/i� —� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER 111 Pc:i� �.'� iC�� �f`���G Phone/E-mail qe,� ��1cG �'���c%'; q,ry� c��\ ,(G�/M <br />' �c 11 1 C`1 r `1 � ^ � <br />CANT: _ Owner _ Owner's Agent _ Contractor <br />NTRACTOR <br />BUILDING PERMIT APPLICATION <br />� ve�C k 1, t�i� , �i <br />COntf2CtOPS Ag@nt _ T@n2nt (must provide a tetter ot consent from the owner to tlo work in the space) <br />L&ILic.# <br />COE Bus. Lic. # <br />m <br />Y11�o�Gj�cJrna�1� C��'1� <br />PRICE OF WORK <br />Existing Use of Building `�-�vJ c�c, :' HEAT SOURCE: <br />Proposed Use of Building '� kvv a �,Sz 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 (add�t�onal space prov�ded on the back) : � � <br />�- 0��"1 �'Jv�ldi�n. U ��c�vo.yt ro�,c'►/,. �k�S 1� by I1 . f� iS vvlc�er <br />2.aQs��� , u ���- � 5' . ► �e. �,��,s��h� a��e {�' ti,, �a� � �4i', one <br />k.o� �h \ o.rt ak�t L SQ � �Q • <br />MECHANICAL PERMIT APPLICATIO PLl:RMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />; A/C — air handling units <br />i Forced air systems <br />� Gas piping <br />� Water heater <br />i Gas fireplace <br />Gas ran e <br />Clothes dryer <br />j Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />s Refriaeration <br />Ducting <br />Other <br />' SUPPRESSION SYSTEM <br />Number of Heads <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />� Lavatorv (wash basinl <br />Shower <br />Kitchen sink & disp <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <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 />1 hereby certify that I have read and examined thls appiication and know the same to be true and wrrect. AN provisions of laws and ordinances goveming this type of work will be complied <br />with whether specfied 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 perform the work for which application is made and I comply with the State Contractors Law 75.27 RCW and 296.200A WAC. <br />� � "`� 4 ���l�if � ? � �1 <br />O Authorized gent Signature Date <br />(Revised 6/2012) <br />