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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: PROPERTY TAX # P IT # � <br />�z�� � 1�0�<«���,�. �v� ootr3��� �� �i�:���z�� �,►�1 ��D���� <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />�NER �� 1V�+�( �1J'v��ltii,t,��%�� 1� Phone/E-mail 7' .� ��t;� • �� � � �1%�i��'j�lz"`Sl�"'� �-`�G�,Vl�l <br />ress �.�� , r�v� � �a City/State/Zip (�� � �,U�" ��� jC���� <br />�LICANT: � Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �musi P�o��de a ieaer oi co�se�� r�om in� owner io do wo�k �n me sP <br />NTRACTOR �-- 1�'�'� �� �� ��T'`�"�'N�`> , 1-�-L-- State Lic. # G��� ���' �'�� �'K } City Bus. Lic. # <br />ress t� L� • t�C-��( ��-�--:�— Phone/Email 3(c�f?• 7C'(.�j�(Qi J <br />VANT BUSINESS NAME CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK d�� <br />Existing Use of Building �' � S< (�F"�--��� �� HEAT SOURCE: <br />Proposed Use of Building �-� 5l (�� Zv(.Jl�� S�/C Gas_ Electric�j Other <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition )( Remodel Repair T.I. Si. n Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />i'(�(�'Gt,�<<-- �-t;'�'VI.O 1��L � ��%T k=F'y',�L 1� :; r`J ���C..� � f=Ei�'C 1=)t. C-= `�,,vi.l. <br />�.�`T t-{ � }�G��j�"�7 L�''= l�l.'l QsL;�v:;�/�'LL Nt��l.t� C�L��b�l �,��� }�-%�,'Li.; (Jl.-t,�r'41E;(t.�t) <br />1 ( <br />MECHANICAL PERMIT APPLICATION I I PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn �Alterz <br />Show Number (#) of fixtures <br />� A/C — air handlinc <br />Forced air systen <br />j Gas piping <br />3 Water heater <br />Gas fireplace <br />Gas range <br />p Clothes dryer <br />} Range hood <br />�- i Exhaustfan <br />Unit heater <br />Boiler <br />ion �Repair Type of Project: _New _Addn �Alteration _Repair <br />Show Number # of fixtures <br />units 3 Toilet <br />�; 1 '=. Bathtub <br />Woodstove <br />f Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Lavatory (wash basi <br />Shower <br />Kitchen sink & dispc <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m< <br />Urinal <br />Drinking Fou <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read an exa ined this applicalion and know the same to be true and correcl. All provisions of laws and ordinances governing this type of work will be comp <br />with whether specfied n or t. T granting of a permil does not presume to give authority to violate or cancel lhe provision of any olher state or local law regulating construction <br />That I a,�� e r of is ope to perform the work fo which a lication is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />� �� ��� <br />O" ner/Authorized Agent Signature Date (Revised 9/2014) <br />\�� <br />