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PERMIT APPLICATION C��� �-C�'�/ <br />BUILDINGfiVIECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St. verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />�4�'- �-v� �/�% ) �, i,N I y I � , � <br />ITE ADDRESS: <br />L� <br />T <br />� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />h i / , . I .. " / 1 . r. / <br />OWNER �V� C� � <br />Address � /��� �� '— <br />r <br />APPLICANT: �Owner <br />CONTRACTOR �j'V <br />Address <br />Phone/E-mail <br />� <br />�'/? �7` N� ICity/State/Zip L._,C�� ��-� L '�,y � ; �,,,7 �. <br />Owner's Agent _ Contractor _ Contractor�S Ag2fll _ T2f1811t (musl provide a letter of consenl from Ihe owner to do work in the space) <br />State Lic. # <br />IPhone/Email <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT <br />Existing Use of Building j�LSL-/ � <br />Proposed Use of Building �, fi �� 1� <br />Building type: _ Single Family � Duplex _Townhouse _ Multi-Family <br />Type of project: _ New _ Addition Remodel �Repair _ T.I. _ Sign <br />DESCRIPTION OF WORK (additional space provided on the bac!<) : <br />i, / C <br />PRICE OF WORK <br />Gt <br />_ Commercial <br />Sprinkler [ <br />� <br />City Bus. Lic. # <br />, <br />�✓ � � <br />�� <br />HEAT SOURCE: <br />Electric Other <br />olition Chanqe of Use <br />� <br />+ � :S i � � �L � ��� Gl%�%�� � %���'_ <br />� <br />MECF!/�NICAL PERMIT APPLICATION �' PLUMBING PERMIT APPLICATION,' <br />Type of Project: _New _Addn _Alteration _Repair <br />Siiow Number (#) of fixfures <br />� A/C - air handling units <br />I Forced air svstems <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 />I / Ducting <br />; Other <br />INKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair ,-' <br />Show Num6er (#) of fixtures <br />� Toilet <br />Bathtub �� <br />j Lavatory (wash basin)� <br />� Shower / <br />Kitchen sink & disp,6sal <br />i Dishwasher j <br />i Clothes washej' <br />� Water heater:' <br />Backfloydpreventer <br />Urinal� <br />Drin ing Fountain <br />FI or drain <br />�rease 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 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 authorized 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 />�1 � <br />� �� ����� � , <br />O Au o¢e A ent Signature Dat � (Revised 3/2013) <br />