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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 />SITE ADDRESS: �.�,Z� / �i � S� <br />b <br />LEGAL for new construction: Short PlaUsubdivisi <br />Iress z.3�� ��C", s�>.�� <br />PLICANT: _ Owner _ Owner's Agent <br />NTRACTOR ,I )e���.� ('a,.�(�fl, <br />Iress � � \,�f • Y ,�� ;� y�r� U`l�r <br />Contractor <br />BUILDING PERMIT APPLICATION <br />PROPERTY TAX q <br />� <br />No. (attach copy of long legal description) <br />ICity/State/Zip t�� � <br />Contractor�S A92flf _ T8f12f1t (must provide a lette� of consent from Ihe ovmer to do work in the space) <br />State Lic. # Q ;1 v �l p i� City Bus. Lic. <br />Phone/Email y� —5J 1 " J�S,��j <br />CONTACT �R PERMIT <br />� �'� � �,v � s <br />Phone/E-mail Lj �-�� j- 5 S� � <br />CONTRACT PRICE OF WORK �O; J�� J <br />Existing Use of Building HEAT SOURC : <br />Proposed Use of Building Gas Electric Other <br />Building type: �Single Family _ Duplex _Townho�}se _ Multi-Fumily _ Commercia� <br />Ty�e of �Lroject: _ New __,__ Addition ___ Remodel y�. Re air �_ T�I. __.__ Sign _.__S�ri..�_ nf<ler __Demuliiion mmChanqe of Use <br />DESCRIPTION OF WORK (additional space provided on the back): • ' , <br />C�.rqS-e �•nS�Q���� i�st,,1�,�,�-,. � �cy�,,���el�e��s:c� <br />n , . , . ��,� , <br />L� w�N�Y f�- �� �, s.z �v s,��. <br />MECHANICAL PERMIT APPLICATION r <br />of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handlin units <br />Forced air s stems <br />Gas pipinq <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes dryer <br />� Range hood <br />� Exhaust fan <br />� Heat um <br />Unit heater <br />I Boiler <br />Woodstove <br />Ductinq <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PL.UAVIBING PERMIT APPLICATION <br />of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Drinking Fountain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other. �+�l��t� <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 yoverning Ihis type of work will be compl <br />with whether specified herein or not. The granting of a permit does not presume lo give authority to violate or cancel Ihe provision of any other slate or local law regulating construction <br />That I am aulho ' by the owner of ihis property lo perform the work forwhich application is made and I comply wifh the State Contractors Law 1827 RCW and 296.200A WAC. ` I <br />�-��3--� � � � <br />Owne orized Agent Signature Date (Revised 9/2014) <br />