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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 />ADDRESS: PROPERTY TAX # PE,�RMIT # y� ,( <br />���� � ll " i N �7 � �" �L' �1 <br />LEGAL for new construction: Short PlaUsubdivision�� <br />OW N E R ,(gU m�IC L/� <br />Addressya� �Cl ��E ��5 <br />APPLICANT: ✓wner _ Owner's Agent _ Contractor <br />CONTRACTOR //'/u,i �C. ,LL�� <br />Address�a�9 ��� � r�E ra� <br />BUILDING PERMIT APPLICATION <br />�y DoG Lot No. � (attach copy of long legal description) <br />Phone/E-mai Q�/�' l/,�"y lx%�� <br />City/State/Zip ��!( � �a%(� <br />_ Contractor�5 Ag@Ili _ TBI1211t (must provide a letter of consenl from the owner lo do work in the space) <br />State Lic. #`� - _. ;'�(9%7�f� City Bus. Lic. # QS3 %y� <br />/I �C Pho�� ��G33' �/a-r�%/,�6C/rr.rz/.E�fI�GS' <br />Phone/E-mail <br />PRICE OF WORK <br />Existing Use of Building � <br />Proposed Use of B�uilding � <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 />�� - ,�,�rc �/a•� ,�8 ��D/- �a� <br />MECHANICAL PERMIT APPLICATION <br />of Project: ✓ New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I A/C — air handling units <br />� j Forced air systems <br />�( � Gas piping <br />t ! Water heater <br />Gas range <br />Clothes dry� <br />Range hooc <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />' Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />�� Gfi��� �� � " ' <br />HEAT SOURCE: <br />Gas Electric Other <br />Demolition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: -! New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />(� j Lavatory (wash basin) <br />2. � Shower <br />J � Kitchen sink & disposal <br />� Dishwasher <br />1 Clothes washer <br />� Sink (service/bar/rr� <br />t ! Backflow preventer <br />I Urinal <br />i Drinking Fountain <br />I Floor drain <br />� Grease trap <br />Roof drains <br />� Medical Gas <br />i 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 ihis 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 oi 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 />�6 �i <br />� ,�mdlJveL � .�"G " f��' <br />; <br />Owner/Aut rized Agent Signature Date (Revised 3/2013) <br />