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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 />SI�ADDRES � IPROPERTY TAX # l I PE� �T,#j �,,� ��� J <br />��Z ll(� �� �� .��t�xi � wA 9�Z� �Z�o � 2`��Oln�3� �7 U (% <br />LEGAL for new construction: ShoR PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER � j��;p,,,_1 �,�.�.-=7� PhonelE-mail Z.S �� �'j,.5 Z�� <br />Address �(Zf ��� S'� .�j� City/State/Zip ��'�T1"L`2_C_ �..: f� r��i!'� Z_-� <br />APPLICANT:� Owner _ Owner's Agent _ Contractor _ Contractor�S A(Jef1i _ TBf78flt (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR � c...,� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building � c' ''� <br />Proposed Use of Building ST'Q--- <br />IPhone/Email <br />TACT FOR PERMIT <br />hone/E-mail � d�T'?r�—� (' <br />ONTRACT PRICE OF WORK <br />t--� <br />BUS. �IC. # <br />HEAT SOURCE: <br />Gas Electric �� <br />Building type: �Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel � Repair T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />i��vc� � � <br />� �'-t� S1C7✓�-5 �C3�"-- C�c2..g�-� Lti�f'.C�� <br />n,( .S � � ( C r � \J <br />Femuv'+��9 �iv� J � uce � � xru��_ �< <c-n�'�r-t- b��c� �z� �cc-�< �. <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 />I Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />; Refrigeration <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />; Toilet <br />! Bathtub <br />i Lavatory (wash basin) <br />� Shower <br />; Kitchen sink & disposal <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <br />Backflow preventer <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />L <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 governing this type oi work will be complied <br />with whether specified herein or not. The granting of a permit 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 authorized 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 296.200A WAC. <br />__ _ � <br />...!'"5----- <br />� S � <br />� <br />Owne ut o e� n.-Signafure D te (Revised 3/2013) <br />