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�RMIT APPLICATIO� <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 />1�v 27 IIZ� 5T �..c �e. h"Z 2��r15[�1r>0401� i�i d�� I���� <br />for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />t G�U `�rJ�'�i �'QOj��TI�� Phone/E-mail �i'7�'✓�Z.�� -2�-3� <br />.� <br />_ Owner � Owner's Agent <br />oR �-; �� b�.��► 5 <br />Contractor _ Contractor�S A9ef1� _ T2f12f1� (musl provide a lelter of consenl from lhe owner lo do work in lhe space) <br />5�.h��ll�- �L&ILic.# <br />COE Bus. Lic. # <br />�� � V UL <br />d�2�r __ i.�,� r� _ t�--1 vc.� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � 25 -, Ol� <br />Existing Use of Building �l �- R'Z�'i�Yl L— HEAT SOURCE: <br />Proposed Use of Building �f7 (�i'�PC1�.sC�� Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition Remodel Repair �i T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />l�i���� IM.P�VGi�1�NT ����u.• �i��i�� i''��t/1�`t�►�l 1 tx�V {-�P�t.lt�iLPCF' ��`� <br />�20tJM ��� i.�►IyYt�l cra W_�cU— fio �� P�i�t'� �� �- y� i� <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/(� _ �ir h�nrilinn �ini}c <br />Gas piping <br />Water heate <br />Gas fireplaa <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Ducting <br />Other <br />RINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of �xtures <br />Shower <br />Kitchen sink & disp� <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Urinal <br />Drinkina Fountain <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 correcL 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 presurrie 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 pr to perform the work for which application is made and I comply with the State Con[ractors Law 18.27 RCW and 296.200A WAC. <br />`1 � <br />r Jf ���i� ' � <br />Own r/A orized t Signature " Date � (Revised 6/2012) <br />