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�ERMIT APPLICATIQ� <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# PERMIT# <br /> ( �'^` Lv�`h S7�sr�'� - ! ►"A r' .�` ,�='( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER Ppr¢p���� Phone/E-mail ZS-ZSt'-3ll0� <br /> Address P O. �j,pX 53�5 City/State/Zip ����f � .Z -zzy <br /> APPLICANT:�Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant 1m�5i Pro��de a ietter of�on5em rrom�ne owr,er io do work in�r,e space� <br /> , <br /> CONTRACTUR �j�Y C('_t'>C �CiO"����` _ State Lic. # City Bus. Lic.# �` , �4 �� s- <br /> Address Phone/Email <br /> CONTACT FOR PERMIT �r�� �r��. ��,�.�.. <br /> Phone/E-mail �2S-.3g$-CXn(.3 u�ti ,fO�v1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building L�u1���c.��•P r+e�o(lcG�r�.rt.f HEAT SOURCE: <br /> Proposed Use of Building /1�ee.J bt,tl.�fL2Qo� cJ�.� Gas_ Electric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of project: New Addition Remodel Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> (GepGz.ternr�$ e6 oCeP 1xt�keaor uxt.21 C�dQ�a�bP�1�o `�$�m� C" �.n dr-a.cvi�s�cw'+'h rce.w <br /> sh¢n�� p�-C� ,�-� i�Ce.c.�dDca,� -ib ��Ge:Q�.��L1�h.a�cqP r�pl�zu�,xez.t'o. Rlso nau-� Ge,�a�.��� <br /> ,.�,.Q�tG2„1e,� a� la�t-a� zw�ra.�.J nea�'Jcru►�erc-t-"IQ r�.r-rc.ca - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units j Toilet <br /> Forced air systems i Bathtub <br /> i Gas piping Lavatory (wash basin) <br /> , Water heater ! Shower <br /> Gas fireplace � Kitchen sink&disposal <br /> i Gas range Dishwasher <br /> , Clothes dryer I Clothes washer <br /> Range hood Water heater <br /> Exhaust fan j Sink(service/bar/mop/etc.) <br /> � Heat pump j Backflow preventer(inside bldg) <br /> ' Unit heater Urinal <br /> � Boiler ; Drinking Fountain <br /> � Refrigeration Floor drain <br /> j Woodstove i Grease trap <br /> ! Ducting i Roof drains <br /> i Other ' Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> ; Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.Ail 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 the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> �i�,/y� '!'��LGl�Q- S-��-�3r <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br /> / � <br /> / <br />