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i • <br />PERIVIIT APPLICATION <br />BUiLDING/IViECFiANfCAL/PLUMBIiVG/SIGN/�PRINKLER/DEMOLITIOfV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ITE ADDRESS: <br />�l0`� ��C� �"��T (��L C�i1i <br />EGAL for new construction: Short Plat/subdivision <br />IWNER L�s��U (Jr°� JI��I <br />Haaress � � 7 � <br />APPLICANT: _ Owner <br />CONTRACTOR <br />ress <br />PROPERTY TAX # <br />IT # <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail '�� ( I c, ��,�-�,, � 4'l P"�`�> r_nG C_C <br />�; �« �-4- -� ? ;Z ICity/State/Zip �� c-,.�'�`(� l-�i f-4, `���C�t <br />Owner's Agent �ontractor _ Contractor�5 A92Ilt _ TEflBflf (must provide a letter of consent from the owner to do work in the space) <br />� C'v �lovv� State Lic. # L I��U���, Z�1;i B�s. Lic. #� <br />� � � ,!` �Cie�� ��' l� �(�'I Phone/Email� �j • I"1 7b�c .6 R� �U�Yi,r< i <br />CONTACT FOR PERMIT <br />Phone/E-mail ;5�� �/ / lGI / b `,1 � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK % 5 �~ �' <br />Existing Use of Building '{" r'' � ( � X �` '� �� �'Gi � <br />Proposed Use of Building �« ,� L <br />Building type: _ Single Family _ Duplex _Townhouse ✓Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler <br />�4�6 .`�a;i 9��'',1 ;�I ''x= �'�!d"'�a;"�'a (additional s��ace provided on ihe badc) ' <br />�� � �� U �� � � 1,t.1'11 �� � ►'�-C� � <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />i A/C — air handling units <br />; Forced air systems <br />Gas piping <br />Water heater <br />i Gas fireplace <br />Gas range <br />� Clothes dryer <br />j Range hood <br />� Exhaust fan <br />� Heat pump <br />Unit heater <br />! Boiler <br />I Refrigeration <br />; Woodstove <br />Ducting <br />i Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />j Number of Heads <br />HEAT SOURCE: <br />Gas Electric � � <br />olition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />j Toilet <br />Bathtub <br />� i Lavatory (wash basin) <br />� Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />i Water heater <br />; Sink (service/bar/mop/etc.) <br />Backflow preventer <br />i Urinal <br />Drinking Fountain <br />! Floor drain <br />I Grease trap <br />Roof drains <br />i Medical Gas <br />i 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 complied <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 autho( ed by the 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 />� � �' I .i� ' f / <br />Y <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />G��°f <br />