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� <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: <br />LEGAL for new construction: Short Plat/subdivision <br />OWNER D/�. �ikf/�ic ��I��Kd v.r�-� y <br />Address �d�3 � %%�'/Jr <br />APPLICANT: _ Owner _ Owner's Agent �Contractor _ <br />CONTRACTOR .t� il� sP�n y �1 � hf 4' <br />Address ? �%J�o J � �/iG d�ll1 ✓�`�! / � � �//" <br />�.� 8/����17D / � ���� �0�?�' <br />Lot No. (attach copy of long <br />Phone/E-mail � ��'rpZp�J� /�'�Q � <br />City/StatelZip �vf.'� r� �� <br />�al description) <br />�f % G`FQ'iT'+0 <br />9�a �� <br />COf1tf3C�Of S/�g@flt _ T8112I1f (must provide a letter of consent from the owner to do work in the space) <br />State Lic. # �'C .f /%�S�%°.�% �7if �City Bus. Lic. # <br />9 r <br />�� � � Phone/Emailp�� 3 ' ��'�%�r �� <br />TE�IAN� USINESS NAME � � CONT�� QCPE� 1Te��� M1L;,����'/� <br />j;�C �'lC Y�i� �� R .-� i� � .,. ��. <br />Phone/E-mail e�1ra� ' %3 'O% J^ <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK P3 9�;. �v <br />Existing Use of Building ��C� �- ���ie� HEAT SOURCE: <br />Proposed Use of Building —5��1 �i Gas_ Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family l�Commercial <br />Type of project: New Addition Remodel Repair T.I. Siqn Sprinkler Demolition Chan e of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />I���1 �� s/�t� i�t1 /'�9/Z�` �^'C� �vT /3 /���i Dl� �'uiG� i,e� Cs�9 c.� <br />�IL�� s�'i9n10 ��G f � �� ) <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />' A/C — air handling units <br />; Forced air systems <br />i Gas i in <br />Water heater <br />� Gas fireplace <br />i Gas range <br />I Clothes dryer <br />i Range hood <br />Exhaustfan <br />Heat pump <br />; Unit heater <br />[ Boiler <br />Woodstove <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 basi <br />Shower <br />Kitchen sink & disp< <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mc <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Medical Gas <br />Other: <br />Other: <br />y�9y� � <br />yagvJ-, <br />�Di�► <br />I hereby certi(y 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 compl <br />with whether cified herein or noL The granting of a permi[ does not presume lo give aulhority to violale or cancel the provision of any other state or local law regulaling construction <br />That I am orized hv lhe owne f lhis property to perform the work for whid applicaCon is made and I coinply with Ihe State Contractors Law 1827 RCW and 296200A WAC. <br />C" <br />� 3 a� �c� <br />w r/Authorized Agent Signature ate (Revised 9/2014) <br />