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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 />AD <br />�`'�AG� RI ��-1j� IPROPERTYTAX# <br />l� C.i..i/1 1 I.�UI <br />-��LZ <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER �(��� �; (7 Phone/E-mail <br />Address �u LJU1L ✓1�� � � J � L� `" � � City/State/Zip ��C,g��� ; �� � ��+'�"—z�(� �% <br />APPLICANT: � Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �m�s� P�o�ide a ianer ot �on5e�i r�om ma ow�er �o do work �� tne SPa�e� <br />ONTRACTOR <br />dress <br />State Lic. # � j � ! > � � j,i� City Bus. Lic. # �%�i4�3`, <br />Phone/Email <br />CONTACT FOR PERMIT <br />» DI�A`f �R. q �S-�� �0 t� �g <br />Phone/E-mail ,�,��'�Y. G. �j���, d(� �(j�j�6 (,l�M <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �� u-.x_.s ;�...::� � c�< <br />Existing Use of Building ��� HEAT SOURCE: <br />Proposed Use of Building M F�7 Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family �( Commercial <br />Type of project: _ New _ Addition i\ Remodel _ Repair _ T.I. _ Sign _Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />.D€',�c c,���.,y C;c;.,s;r�v�-�7G� �:�r �—v,2 77� �7 <br />'�G ���Jti�% �Ci::/' �.��—.ME� �',-�rc:�� c''jr <br />��i .S;�AG,.,?y CX+�+"� � <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />� Water heater <br />� Gas fireplace <br />� Gas 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 />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <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 & disposal <br />Dishwasher <br />� Clothes washer <br />� Water heater <br />Sink (service/bar/mop/etc.) <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 irue and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granling of a permit does not presume ta 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 />{� ,�, / �1� <br />k'�J�Lz�v�'__ �"2�� //-; <br />Owner/AutFwf'ized Agen ignature � Date (Revised 3/2013) <br />