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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 />SITE ADDRESS: <br />7ol(a r3eJe�l �Id'cr E��re:F-i- �,:�1 `?�z� � <br />LEGAL for new construction: Short Plat/subdivision <br />OWNER �he,--le T�, i ��,,� 4 Phone/E-mail �c;. $5;Z-`73�� ,Lrv �be�ILC ,n��;�.cvm <br />Address /yC;Z`7' (cz �� �{vL SC City/State/Zip �v��^zr /- (�.)/-� % fC'zCi �'; <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant em�s� pro��ae a iet�er ot conseni trom cr,e owner eo do wo�k �n er,e s�a�ei <br />CONTRACTOR l� / A <br />'ROPERTY TAX # P RMIT.# + <br />co =�`� Z� c:r� I vU �7 c e� ��� � I�-i � I- <br />Lot No. (attach copy of long legal tlescription) <br />ress <br />State Lic. # <br />IPhone/Email <br />NTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />City Bus. Lic. # <br />Existing Use of Building ��.�.�c:�����,L qco �:.�� p/1ci� - rz�c:�.r�n{;ci.l HEAT SOURCE: <br />Proposed Use of Building .��M��iSr� Gas Electric Other X ^����z- <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler X Demoliti <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />- c1�rti�c1�S4•� =�i-«;.c�-�.�c� ( 1��_che_d ��-: �-���> o <br />Ov392,gG /OG`7GG <br />- c��-vti � 1� S lti s i-t-U c�-t,� c�. ( o v_:-�o o r s� c-a� e_.> <br />Chanqe of Use <br />� �'�-��'�C;I�Si� 7�-(l,�C�--t,.�L �11Gd1- S��.SiC�:..i��"I�'`11 U�=S j%�,C=;�%IGO'iG� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _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 />Clothes washer <br />Water heater <br />Sink (service/bar/mop/E <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 />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 authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors law 1827 RCW and 296 200A WAC. <br />.._. ��/�• �.c�, � <br />_' . l.."� �. /� <br />---�'f_ �- : -C C_ f��,fi.�, zc�y � � <br />OwnerlAuth,orize Agent Signature Date (Revised 9/2014) <br />