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PERMii' APPLICATION <br />BUILDINC/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 />'E ADDRESS: <br />�� G? JGt G <br />,i+� � hi2c^ 1 <C � <br />�i� 4.: L L�j�'Z.'J'ti L,, <br />LEGAL for new construction: Short PlaUsubdivision <br />OWNER %,/Y!z ��e�! �J- / l�c.^.�-�- <br />ress y��� �%l�` <br />'LICANT: �wner <br />ONTRACTOR %�� <br />dress <br />A <br />U!/ /�-Gv� <br />��✓� 5� <br />_ Owner's Agent _ Contractor <br />BUILDING PERMIT APPLICATION <br />� ,,-. PRO�P�ryERTY TAX 1# , � 7 ,� � PERMIT # <br />�lb.'C'(��xJ.�=%'t'{� ��•}� � i ' <br />Lot No. (attach copy of long legal description) <br />Phone/E-maila�JG % I-1 '��5�/ T��,�"fio,^rr�r % j "=��'n�c�,'/.t <br />p City/State/Zip ��/ef`e �} C� �i�C�� <br />Contractor�S A9ef1Y _ i 8f18f11 (must provide a letter of consent from the owner to do work in the space) <br />State Lic. # <br />�Phone/Email <br />CONTACT FOR PERMIT <br />hone/E-mail <br />ONTRACT PRICE OF WORK <br />Citv Bus. Lic. # <br />Existing Use of Building _�-���,1 I� Cc i��L,B^� HEAT SOURCE: <br />Proposed Use of Building�� � ��J` W�� 1'-�:. ^^- Gas Electric t��Other <br />Building type: ��ngle Family �uplex _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) : % �T <br />J�v�� ba-�hro�� vv�r ?,: � - -- � -- -- <br />f�r?�G�LZ rr�e.nol� c(s�Yr c,,,;-i� 5����C 3`c.. ��a�r —CEt�uc{C� EiX�s'�;�,�� �-��sc:ur�^ <br />(-2�I��Cc �X i � � /ne..,) G!` x L � �UC(,�-. .,.Gtci�t ��� %6il� � ��C✓C��C Le��'•^� ��'� } <br />S-�,�r<<< c �� w;� 1... <br />' ����,+. <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn ✓Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C - air handling units <br />3 Forced air svstems <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 />; Refrigeration <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New _Addn V Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />/ � Lavatory (wash basin) <br />/ i Shower <br />j Kitchen sink & disposal <br />I Dishwasher <br />; Clothes washer <br />�_..�---""'� _...aA(ater heater <br />Backflow preventf <br />Urinal <br />Drinking Fountain <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 the same to be true and correct. All provisions of laws and ordinances governing this type of work wiil 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 cf any other state or local law regulating construction <br />That I am authorized by the owner of this property to per(orm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. � <br />� � <br />/,�t,.., �i`�� % rF�,�„-� U ) _ �- } - i � <br />Owner/Authorize�gent Signature Date (Revised 3/2013) <br />