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� . <br />� ( . . ��� , <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS: PROPERTY TAX # PERM T# <br />-a� �t�a �I 5os�00060�0� ca,� � t�o� - c� z <br />�AL for new construction: Short PlaUsubclivision Lot No. (attach copy of long legal description) <br />'NER ���lL (�Q I�e/' fi %l%% l"f l/? fi ( Phone/E-mail �f'�� �(fl ^� �f� Q�} <br />ress %LD (o {�(/ l'n(�[�l�Q ��/� City/State2ip �!/C/'GL� �/j/� Cl`�zQ 3 <br />_ Owner _ Owner's Agent ,� Contractor _ Contractors Agent _ Tenant �musc prov�ae a iener or consem rrom �ne owner co do wnrx in Ne sPace� <br />i" i �l � � ,,. � . <br />BUILDING PERMIT APPLICATION <br />& I Lic. # SuTt+`/ff /3ZfI� COE Bus. Lic. #�� <br />% Phone/Email 7i(��p -7�3-����j <br />ONTACT FOR PERMIT <br />PRICE OF WORK �>�� • OC <br />Existing Use of Building _K��cCi'l•��C� � <br />Proposed Use of Building �` <br />Building type: �Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New ✓Addition Remodel Repair _ T.I. Si n_Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : 9lLQ �%G GKg <br />/� �� r; � � N� G�s .��r�c�`v�r-f-f��cP �r« ��sr.r� <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Num6er (#) of fixtures <br />A/C - air handlin units <br />Forced air systems <br />Gas pipin <br />Water heater <br />Gas fireplace /J <br />Gas range <br />Clothes dryer <br />Ran e hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refri eration <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />Other <br />Ie of Use <br />� <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />►vtcnen sinK t� ais <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/ <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 goveming this type of work will be complied <br />with whether specifled 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 Iocal law regulating construction <br />That I am authorized by the owner of this property to perform the work for which applicaUon is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� <br />�`�'��� � �� i����' �3 n o ���v�, � �F�� s o �v e� <br />Owner/ thorized Agen Signature Date � (Revised 6/2012J <br />/��� �� � ��� �� <br />