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• <br />• <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 />ADDRESS: S3 j(� �f E G��/CC'%/ iJI%fLG Ub'/i"`I PROPERTYTAXti <br />E_�, c'i2N T T ��'f=? ���_z�=.Y _ <br />GAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />,/�'J j��% , ..�� ���75 . <br />JNER : i �Tl�lr C. � �����/ �/ i ��'� �E��L' %'C �� Phone/E-mail � �� f�S 7 � C / ;/ � �„y'L"; L�.?/'vl <br />� G Se� �= v'��2� TT .�7 v � � v p � ��'/�' �� G'Z�� ✓>���'`�"� �i <br />iress - ��� � L" G� , 2 � " Cit /State/Zi � <br />fN <br />PLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �m�5c P�o��do a iener oi �o�5e�� rrom tne owner �o do wo�k �n �na SPace� <br />NTRACTOR ��1 `.• 0�� f i� ; i1� C Lib1��1''� State Lic. #�,� `> �`�,-�-� � SX !��- ( City Bus. Lic. #�r : i i�? i=7, C J <br />�arv2s�- C�-��S�iar� C���� <br />BUILDING PERMIT APPLICATION <br />Phone/Email <br />CONTACT FOR PERMITA/��jj /}� �/G ' <br />/d <br />Phone/E-mail �� �. � ��� ��� � <br />CONTRACT PRICE OF WORK ���_ � <br />Existin Use of Buildin �� � �' � <br />g g � l A�� -i I x'�.� �Gf�_ � ��UO�j"�/i '� HEAT SOURCE: <br />Proposed Use of Building � — <br />Gas Electric_ Other <br />Building type: _ Single Family _ Dupie;; _rownhouse _ Multi-FGm�ly �� Cornmercial <br />Ty e of rojecl: _ iJew _ _ Addition __)CRemodel __ _ Repair __ _ _ T�L _ __ Sign _ ._,_S rip ni�:ler _ _. Dei�olition __Change of Use <br />DESCRIPTION OF W�RK (additional space provided on the back): / ' , ' � , ' ,T �� ' <br />�G. "IG%I ( i�' �i �i'��'��E � fC .��/�L(: l.'ivZ- � <br />� � J <br />E.' ��, 5� ! � �' �ti ,r.E:'.�.' fl �' � � , a �l f �-� r /� r�,�' �1 ��'�n � l��a �� -t.� �� c���, �.:-� <br />/f�SG' J'.�li/��<1'i✓'b�' ✓)���`c�r' �Li���(' i�� C-��c�i.�"�<' ���: E�:;��'i('Eri�l 1�%1�� <br />�G> � , f' !� .�/l.' .�¢'�� �.' F' <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />of Proj�ct: _New_Addn _Alteration _Repair <br />Show Number (#) of fxtures <br />A/C - air handlin units <br />Forced air s stems <br />Gas i in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes dryer <br />� Ranqe hood <br />—� Exhaustfan <br />Heat um <br />Unit heater ' <br />Boiler <br />Refri eration <br />Woodstove • <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash b� <br />Shower <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/r <br />Backflow prevente <br />Urinal <br />Drinking Fbuntain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certiTy lhat I have read and examined this application and know the same to be lrue and correct. All provisions of laws and ordinances governing lhis type of work will be compl <br />with whether ed erein or not. The granting of a permil does not presume to give aulhority lo violate or cancel the provision of any other state or local law regulating construction � <br />Thal I a ulhoriz y th�own�r of lhis properiy to pertorm Ihe work for which applicalion is made and I comply with the Slate Contractors Law 18.27 RCW and 296.200A WAC. � <br />� !i , . <br />� <br />_,,� ,�= 3-S a�.�� <br />Owner/Authorize Agent Signature Date (Revised 9/2014) <br />