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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: —� „ , PROPERTYTAX # PEFtNJIT # <br />jv �� ��d, I��y" ��- c�:) y 37��7 ZS �%u� l', r�C�� _ r' C- <br />�, <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER KV!UtSl�lil �(�U �c�f il '� �� Phone/E-mail `%Z`_� —�� 7'(�JLi � Idn"r� CC:C�,Sj'�. <br />7 � <br />Address Lj� v�� � City/StatelZip �S���d� L� �-'(�f G�<� 9�`�i <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ Contractor'S A98f1[ _ T@fl2flf (must provide a letter of consent from tae owner to do vrork in the space) <br />CONTRACTOR C��G'>21-!' <br />L&ILic.# <br />I Phone/Email <br />ACT FOR PERMIT <br />E-mai l �� L S " :� L 7 ' � � �> � <br />COE Bus. Lic. # <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '��v��G�iC� "— <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric=x Other <br />Building type: C� Singie Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: u New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additronal space provided on the back) : <br />,�/ �! cJ' /'"'Y';/!/t�. : �T �" C' :� <br />' /�t� LC_i�'`�iv� � <br />MECkANECAL PERMIT APPLICATION PLUMBING PERMI'T APP�LICATION <br />of Project: _New _Addn _Alteration _Repair <br />Sh�w Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas pipinq <br />Gasf <br />Gas r <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />/ Refrigeration <br />Woodstove <br />� Ducting <br />� Other <br />tINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />Toilet <br />2, Bathtub <br />Lavatory (wash basin) <br />� Shower <br />( Kitchen sink & disposal <br />( Dishwasher <br />Clothes washer <br />Backflow <br />Urinal <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 lhe same to be true and cortect. All provisions of laws and ordinances governing lhis rype of work will be complied <br />with whether specified herein or not. The granting of a permil does not presume to give authonty to violate or cancel the provision of any other state or local law regulating consiruction <br />That I am aulhorized by the owner of ihis 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 />5-z�13 �lz- <br />O u hori e Agent Signature Date (Revised 6/2012J <br />