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c <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 />SITEADQRESS: t ✓G -E�/�`� PROPERTYTAX# �winir�# <br />y�S �Sa�- s; s�� ���' �c�� tl3� 3-� � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER t- L'c i-' c=: ; I /-/c� C• `� �ti/ �. Phone/E-mail ../ 2 7-.�'� j.-// 5''$' <br />Address o c�.-� ��(�� ��i,�t.�." City/State/Zip L- 1/E,� c j� � �¢ c) �=_ �' l <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor'S A9Qflt _ T@f18f1Y (must provitle a letter of consent from the owner to tlo work fn lhe space) <br />CONTRACTOR �1�� c�/t! S�'S �� S L& I Lic. # t(r,y�/�'��, /'f�C COE Bus. Lic. # <br />Address ���D�� i3 5' F"' /��. S C /17� G L, Gj<'6 c: /C Phone/Email !�,) S�_� S j �!/, � <br />L l�I IC t{��. �/�: ' � iLh'N � �- ��'/ <br />BUILDING PERMIT APPLICATION <br />'��L� % � L� <br />�,5 Phone/E-mail i�/�7S -3 5 � -r/"��-� <br />CONTRACT PRICE OF WORK � ��U • � �� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Eiectric <br />Building type: _ Single Family _ Dupiex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition Change <br />DESCRIPTION OF WORK (additional space provrded on the back) : <br />� �=�- � :���� 1��� � J d v�,n � � � V1�d � <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of flxtures <br />A/C - air handling units <br />Forced air sVstems <br />ace <br />Exhaustfa� <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION <br />Number of Heads <br />of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8� disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Urinal <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />in <br />I hereby certify that I have read and examined this applicalion 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 specified herein or not. The granting of a permit does not presume to give aulhority to violate or cancel ihe provision of any other state or local law regulating construction <br />That I am authorized by the owner of ihis property to perform the work for which application is made and I comply with the State Conlractors Law 1827 RCW and 296.200A WAC. <br />-----�-' ��---'�-- `/.,�. <br />� <br />Owner/Autho ized A�gnature Date (Revised 6/2012) <br />