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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 />SITE ADDRESS: > ' <br />l Z1 f �-� r .�-r �- <br />LEGAL for new construction: Short PlaVsubdivisi <br />OWNER T�j'�' 1 � <br />Address �� �(�X <br />� S �1� <br />PROPERTY TAX # <br />IT <br />Lot No. (attach copy of Iong legal description) <br />Phone/E-mail �C/� G'G � �G ��� <br />City/State/Zip SyJ�f�G1 !)i2r1 A S�\ 1'��f7' �n <br />Y <br />LICANT:(� Owner _ Owner's Agent _ Contractor _ Contractor�5 A9011t _ T2f18f1i (must provide a letter ot consent irom the owner to do work in the space) <br />ONTRACTOR /(/Q <br />NANT BUSINESS NAME <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building L�l��"���� <br />State Lic. # <br />Phone/Email <br />Citv Bus. Lic. # <br />)NTACT FOR PERMIT '��L�-� l� �C�� <br />d <br />one/E-mail !'iv��j !�� �z�5 d/C��l �l � ,�� �L. � C ( iM <br />)NTRACT PRICE OF WORK �.��� <br />HEAT SOURCE: <br />Proposed Use of Building _it.i- �l•✓� I%'�I%�'f' 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 (additiona! space provided on the back) : �� <br />,, � �.�- � r-��CJ �j <br />i en,,o l � s l� �'�?� ������' S�,'t /�' �/ <br />`� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />I A/C - air handling units <br />� Forced air systems <br />Gas piping <br />j Water heater <br />! Gas fireplace <br />i Gas range <br />! Clothes drver <br />� Exhaust fan <br />Heat pump <br />; Unit heater <br />-� Boiler <br />j Refrigeration <br />j Woodstove <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />! Toilet <br />Bathtub <br />j Lavatory (wash basin) <br />� Shower <br />j Kitchen sink & disposal <br />Dishwasher <br />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 />I Grease trap <br />i Roof drains <br />� Medical Gas <br />i Other: <br />� Other: <br />I hereby ceriify 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 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 th this property to perform the work for which application is made and I comply with the State Contraclors Law 18.27 RCW and 296.200A WAC. <br />, � _ � /" <br />1 y/ <br />Owne thorized Agent Signature Date (Revised 3/2013) <br />