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� e`rn�.i\ 'c��,�\��v � �jre��cs�d h�.a��c� csm <br /> � � <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 /> SITE ADDRESS:��` �� � ^�n PRO'ER� T��� �1� � P� lyt/ / , G� <br /> f� ��� � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER � C Phone/E-mail �' �� "��{� 1 <br /> Address `�� ` � �� City/State/Zip ����� �- �- ���Z�1 <br /> APPLICANT:_Owner _Owner's Agent Contractor _Contractor'S A98f1Y _T2f18f1t(must provide a letter of consent from Ihe owner to do work in the space) <br /> CONTRACTOR •� � L&I Lic.#C E��� l,'t COE Bus. Lic.#� �� <br /> Address � Z S �`�� i �� l.. � Phone/Email ������—�t� <br /> TEt:ANT Sl7SINESS ME �O(dT,•^,CT FOR PERh1�T �5, �`el <br /> ��,�� ��Y�,Y1,L:�-����"� � <br /> Phone/E-mail �� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � �.�Ci�aC� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of pro'ect: New Addition Remodel Repair T.I. Si n Sprinkler Demolition Chan e of Use <br /> DESCRIPTION O WORK(additional space provided on the back): <br /> � 1` ` � � '� , M.1 � 1. M/� vl�J.�IV�1 Z , ..�G'fuSl�% <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: �ew_Addn _Alteration_Repair Type of Project: _New_Addn _Alteretion_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran e Dishwasher <br /> Clothes dryer Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink (service/bar/mo /etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certiiy that I have read and examined this application and know the same to be true and correct.All 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 propeKy to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> 1i l� <br /> Owner/ uthorized Agent Signature ate (Revised 6/2012) <br />