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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 />ADDRESS: S�' � Z. �j ' �(J"G L )' <br />EGAL for new construction: Short PlaUsubdivisio <br />WNER l;/-( J�� <br />idress ``J'� 2--� <br />PPLICANT: �Owner <br />TRACTOR <br />BUSINE <br />S 5 C 1� �. y L%�iL <br />��G- G, j' f��, t=�=�-_ :;: <br />Lf� <br />_ Owner's Agent _ Contractor <br />BUILDING PERMIT APPLICATION <br />OPERTY TAX # P RMIT <br />������-- <br />Lot No. (attach copy of long Iegal description) <br />Phone/E-maii /'rj/� ).1,9'1 <br />! �City/State/Zip � �� r�� %��� _ s�'J � icl' <br />Contractor�5 Ag0f1I _ T2f1811t (must provide a letter of consenl from the owner to do work in lhe space) <br />State Lic. # <br />Phone/Email <br />Citv Bus. Lic. # <br />��zG,(�� y7t`���f�S'���.h_��'��j"e�ctiC�'Yu%�:-�.4;-i-:� <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building 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 Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />�Ni���� �(i�(% �R-�'!x/y �- � �f �-' <br />�/� Jl ,, U � L <br />�NU� i 7v2�i '�%�!(5�lf'Z� G���G'GZ�"� �`�'SSUY'y`�ils��i,�� ��CY'7�LI/ �LC+/!�l'L )'�"!°li^/U� ��GC�i <br />� ,�JC��%u- Gi�P/L�! O � � Er�� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />A/C — air handling units <br />( Forced air systems <br />! Gas piping <br />" Water heater <br />j Gas fireplace <br />j Gas range <br />� Clothes dryer <br />( Range hood <br />—� Exhaust fan <br />Heat pump <br />j Unit heater <br />—� Boiler <br />� rtetngeration <br />; Woodstove <br />' Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />' Bathtub <br />� Lavatory (wash basin) <br />� Shower <br />; Kitchen sink & disposal <br />i Dishwasher <br />j Clothes washer <br />i Water heater <br />I Sink (service/bar/mop/etc.) <br />; Backflow preventer <br />I Urinal <br />; Drinking Fountain <br />� Floor drain <br />� Grease trap <br />Roof drains <br />j Medical Gas <br />i Other: <br />! Other: <br />I hereby certify thal 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 of 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 applicalion is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�„ � l <br />� � '� �L��- %�7�%�� �. <br />-/�,,x„ ls �' � � . <br />Owner/Authorized Age Sig ture Date (Revised 3/2013) <br />