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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: PROPeRrv Tax q PERMIT # <br />�yU2 12uckcr �dv� UUK3�5.�295U3/av �� ��� �m� �I <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER (j�. G�alt� J��7"C /7 Phone/E-mail <br />Address lyU2 �uGku�- V(L City/StatelZip �vrr�� Gt�q �J�2Ul�/6/6 <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor'S A9@flt _ TEflBflf (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR �' /%�I N/��I�C��� .j,yl� L& I Lic. # v��rl �9��i COE Bus. Lic. # <br />�/�� � / � C CC I'G i A� CGN'. G U� <br />Address 1'I �%, %�j�c ��6V �.A� .li�✓!'�'1S, G(/a �1'� ls � Phone/Emai12�JFJ ^p�9"Up.i_� Q�/'�-rr�i '/, �,,.r. <br />BUILDING PERMIT APPLICATION <br />uJ,r,k /, 2�c- � � 9 -�bs'l <br />��� t�l �c���� �a,sfru�tiu� �G-�na,'/, c�! <br />:T PRICE OF WORK %SUUU� �'%d <br />Existing Use of Building ��Ct+'dlqL� HEAT SOURCE: <br />Proposed Use of Building_��cfi�'Y.�K.�i <br />Building type: �Single Family _ Duplex ^Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New Addition �Remodel Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />//I��`;� ��cc Ic �'�nc� K�� ir%:7 � rrr� G�'� � <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A!C — air handling units <br />Forced air systems <br />Gas oipina <br />c�as range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />� SUPPRESSION SYSTEM <br />Number of Heads <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn �Alteration _Repair <br />Show Number (#) of fixtures <br />j Toilet <br />Bathtub <br />� Lavatory (wash basin) <br />( Shower <br />/ Kitchen sink & disposal <br />Dishwasher <br />vvater neater <br />Sink (service/bar/m <br />Backflow preventer <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 corcect. All provisions of laws and ordinances goveming 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 pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />-_-� /'/� /y �` Z� <br />uthorized Agent Signature Date (Revised 6/2012) <br />