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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: PROPERTY TAX # PERMIT # <br />� Z:'s 3�� �vc.-�-r-r E 11 � 53�� 9C�-�3 ��353�i'I G2 1C ..��' <br />LEGAL for new construction: Short PlaUsubdivision ,^,G �}� � I� 73�G I 7��.r Lot No. (attach copy of long legal description) <br />I i � I <br />OWNER M .. � �n � 1 f� ���r ct Y.' : „ � �� i Phone/E-mail � 4 � —1 � � . <t 5 ?3 � 5��: � f � r ��,• ���C <_ -1 �� �_ -✓ -� I�c < <br />« ;,, <br />Address �� Z � � l y�"' ��. �.V C � �. �`i i�,' l� `i ?� ? t� j City/State/Zip �v " �- r-F �- r(,v ;l /`� � ��' 1 <br />APPLICANT: _ Owner _ Owner's Agent � Contractor _ Contractor�S Ag@f1Y _ T@fl2flt (must provide a letter of consent from the owner to tlo work in the space) <br />CONTRACTOR r1 C G+.t l��a�-� _..� 5'�c� I � ta �, c� :� .� L& I Lic. #,�C L i�� R � v�,; � y- �OE Bus. Lic. # Q+� "3'� <br />Address �� ��1 GVI.�-� °irt� �ticx GVa' '� ;Ff, (^-�� Phone/Email 1.�`.�i-3 3(.i _ `3..%�y �w.c;���nu.,,, �Y,�'G�- <br />TENANT BUSINESS NAM CONTACT FOR PERMIT �'' ��ai�, <br />SrtF ,? ,-«1 �fU t� �c� f �..,c� �., �� �� �!:v �� � w � _, �- � G1` � <br />1 <br />PhonelE-mail �}1 �—�'�`�-- `7 3`�U�'-f jl �%T�,�, ts„ �,s, 4c: :.� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3 2=�,?� <br />Existing Use of Building ��. � i; ��y -��� c �� <br />Proposed Use of Building .S �i w, � <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition Remodel Repair _ T.I. ZC Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />HEAT SOURCE: <br />Other <br />Chanqe of Use <br />!VC'�� i I�q :��j' � � �.. I �C:�� irt-FLe _ 1-I �-- �' , !c�! f -� 2 <br />.r - :2 ✓ f� -'� <br />� � � <br />3������ �.�.�� �_�:.,��� ���-� ���.U��� �, ,Z�� � �r�, �� ��--����7�� � <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />ofProject: _New_Addn _Alteration_Repair <br />Show Number (#) of fixlures <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 />Exhaustfan <br />Heat pump <br />! Unit heater <br />Boiler <br />1 Refrigeration <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />'i Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />I Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Backflow preventf <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 goveming this type of work will be complied <br />with whether specified herein or not. The granling of a permil 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 authonzed 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 296200A WAC. <br />,�y��'� - �1-�-I <br />Owner/Authorized Agent Signature Date (Revised 6/2012) <br />��Z <br />