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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.ever�ttw�� rg <br />APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �— � <br />ADDRESS: PROPER TAX # PERMIT # � <br />1 � Z.'I � �2 _� -r � L, , ��u° c. r� � �� �'�� �-ia � ��� �-�� �'t� 0�5 <br />AL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />JER (-� �.� ,3.._ Z, ).}�tf-�-6'ri'J� ` �- � S� Phone/E-mail <br />�ss City/State/Zip <br />LICANT: _ Owner _ Owner's Agent _ Contractor� Contractor�S AgEf11 _ TBf18f1Y (must provide a letter of consent tmm the owner to do work in the space) <br />NTRACTOR � \r'� {.,�Q,� lR��,.,� Ic� �,jW L & I Lic. # -4-J� '� - ��C1v ��� � � COE Bus. Lic. # <br />ress � i� L� L� i�� �f� �•y L� �. �r SY�`� y�J M'� S G� ,r�,� i�-� Phone/Email �bU ��� �`�`'V, �� � <br />r->.�%.� ►-�2,-� fL��-+� � <br />` � .-. <br />� ;-r�. <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building <br />�.,/�VVk`i��'�"i-- R�� <br />=-mail -�,' f�5r'�C.�21'������mi„ �. ��Cl'S' i��� � '• �t7� <br />RACT PRICE OF WORK L_ ,5�� ��'� <br />HEAT SOURCE: <br />Proposed Use of Building � Gas_ Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Chanae of Use <br />DESCRIPTION OF WORK (additional space provided on the back): � <br />/� � LJ i� l h w l� z 9� t�.S� :�.1 t`' �.�� c.;:�.: �:�� o-�' �:-� �:.��-r v�-� �L �� <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <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 />Woodstove <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Num6er (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disaosal <br />Clothes washer <br />Water heater <br />Sink (servicelbar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medfcal Gas <br />Other: <br />Other: <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 goveming this type of work will be complied <br />with whether spec�ed herein or not. The granting of a permit does not presume to give authonty to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorize y the owner of this property to perfortn the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />_Z�� �� <br />Ow er/ uthorized Ag t i a ure Date (Revised 6/2012) <br />