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PERMIT APPLICATION <br />BUILDlNG/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 />ITEADDRESS:��� �A/ C.AC/i./i1 ,�1� t' �-rj��R PROPERTYTAXq fjlV�l��'�D <br />{� <br />GAL for new construction: Short PlaUsubdivision <br />VNER I-`�UI�INC: Jlal��',.rF'� .�iG4(// <br />ress �� (� � � � � � <br />NTRACTOR JJjl�1��Ul�li� �,� �1(5i�%-'"�1C�TC)�'� <br />ress ����% /�k� �r'j" I�2 , l�rLU N ��tlErA , i <br />BUILDING PERMIT APPLICATION <br />Lot No. (attach copy of long legai descripiion) <br />PhonelG-maii � �'" � � j ' % L� � <br />Ciry/Slate/Zip S���I� �V � ��/ `� L>( L � <br />L & I Lic. # �IA(4/�(J�� �,��j(p <br />��+�c�..f.�, Phone/Email j�;;(,�. %��, :3L ��CJ <br />PhonelE-mail />'� /� C 17,s:1�1 C`� <-t t.� l4/ � wf'�1 c+.11 c('h <br />COPITRACT PRICE QF YYORK Z�-��TS�t'_v" �����. �v�� <br />Existing Use of Buiiding i�/FW �.i�,�VS� /_'-�l (,TiCihl HEAT SOURCE: <br />�roposed Use of Building ��/�S"Y IfU/N�f� �--Esvi,v�N'% ____ Gas� Electric_ Oiher <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commerciai <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.i. � Sign _Sprinkler _Demolition_Change of Use <br />Description of Work (additronal space provided on the back): <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _,Alteration _Repair <br />Show Number (#) of (ixtures <br />� A/C — air handling units <br />J Forced air systems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ranae hood <br />Heat pump <br />Unit heater <br />� Other <br />SPRINKLER ! SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of ProJect: _New _Addn �Alteration _Repair <br />Show Number (#J o/ fix(ures <br />Toilet <br />Bathtub <br />^ Lavatory (wash basin) <br />S hower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />� Sink (service/bar/mop/etc.} <br />1 <br />� <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease frap <br />Roof drains <br />Medicai Gas <br />Other: ���N� j�� <br />otner: �,v1�c� S <br />I hereby certify that I have read and examined this application and know the same lo be lrue and correct. All provisions ot laws and ordinances governing <br />ihis type of work will be complied with wfiether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />ihe provision of any other state or local law regulating construction or the performance of construction. I hat I am authorized by the owner of this property <br />to pertorm t�ie work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />/ ' �Lf�=E'� /'�T/d�/1w1�6�-- /2 Z i �Z�,, <br />OwnerlAuthorized Agent Signature Date (Revised 2/2011) <br />i <br />t <br />I <br />