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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITV' OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: PROPERTY TAX # PERMIT # <br />' � %/ �l !�'�.�'/'f; � /�I _�.� �',r�'/'�'i— L,.�f,t`'r'1 >> � � � � � — U � �- <br />LEGAL for new construction: Short Plat/subdivision_ Lot No. (attach copy of long legal description) <br />idress `} � /1/ %''� <br />PPLICANT: � Owner <br />NTRACTOR <br />Owner's Agent � Contractor <br />BUILDING PERMIT APPLICATIOI'd <br />Phone/E-mail <br />City/State/Zip <br />Contractor�5 A9@Ill _ T2�ell[ (must provide a lel�er of consent from the owner to do work in the space) <br />State Lic. # f�(� i,�i ���%3� �S �.c�tv aus. �ic. # <br />IPhone/Email <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building �"� <br />Proposed Use of Building ��d�` [',o;�i1^s�7s��4.,,-�,z���Esi%�,.�;-:i1f � � <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: � New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _ <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />>v''�'�„ �.�r'f����r�v,�.f �'�7�'��' C��' ��ti�"P-- s:ye.�i-�i— �SF�-� <br />MECHANICAIL PERMIT APPLICATION <br />pe of Project: �New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />�''�j A/C - air handling unil:s <br />�/ � Forced air systems <br />� � Gas piping <br />� Water heater <br />r ; Gas fireplace <br />� i Gas range <br />j � Clothes dryer <br />�f Range hood <br />—r `— � Exhaust fan <br />�� Heat pump <br />L> � Unit heater <br />Cj—� Boiler <br />�"; � Refrigeration <br />!`, I Woodstove <br />SPRINKLER / SUPPRESSI�N SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />Electric Other <br />ion Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: j�New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />`z� Toilet <br />� Bathtub <br />-��y' j Lavatory (wash basin) <br />� j Shower <br />j i Kitchen sink & disposal <br />/ Dishwasher <br />�' i Clothes washer <br />� i Water heater <br />� ; Sink (service/bar/mop/etc.) <br />�� � Backflow preventer <br />�� I Urinal <br />�'� i Drinking Fountain <br />j,,'► I Floor drain <br />� I Grease trap <br />n j Roof drains <br />�j j Medical Gas <br />� Other: <br />i Other: <br />I hereby certify that I have read and examined this applicaticn 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 permil 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 aulhoriz� e 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 />; ` ` � <br />% � <br />/y, r�" ? <br />f <br />Owner/Authorized Agent Signature ate (Revised 3/2013) <br />