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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 />�'E ADDRESS: PROPERTY TAX q P. M# <br />� 003 w. cAst rla iLD F�r�.�rf ai.DG �=k: -�"� �i � ��-�' � L <br />L for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br />OWNER <br />Phone/E-mail <br />idress Pb Q oY 31 b1 M � S � N- t 3 I CitylState/Zfp S�RTTI..E � W Pt 9 b i 2� - z �,0'� <br />PPLICANT: � Owner _ Owners Agent _ Contractor _ Contractors Agent ._ Tenant (m�9t provide e iener orconsen� rrom me owner �o do wonc in a,e sPa�a� <br />` ' � (�t i= ( <br />� (=.1'� � � <br />BUILDING PERMIT APPLICATION <br />State Lic. # SLN VC �, �C I Z I N C.. Citv Bus, Lic. # <br />Phone/Email <br />SE�F DRA�l�P. 'Y�,�-2.34-019� <br />hone/E-mail ,)E.FFERY• G, DRhY6.R & BbEtN6. CnM <br />ONTRACT PRICE OF WORK $�� •�� 0-�'�� <br />Existing Use of Building P� Fb HEAT SOURCE: <br />Proposed Use of Building M�u Gas_ Electric_ Other_ <br />Buiiding type: _ Single Family _ Duplex _Townhouse _ Multi-Family X Commercial <br />Type of project: _ New _ Addition _ Remodel X Repair T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provlded on the back) : <br />�C.f^c,'l.,i�Tl�l., �7.' �`it,/''`���,v;�;L� i.>;'L1.,S �;;i kEi'LRCaI�L� �1�'!i-d hl��',,/ll�/'LC� TZ� L-/'.1�� <br />F �C ,v t`��.1> ti vt- ��.�,�- �' �� 'f'! L� U l� � L ai�1 [�� u i L� �� f L' f' ' ' <br />,� c,'�` �" i rl c� p � � P'�r I,�� L s� <br />' "' ''' C" 1� <br />(1 � ) _, � r'�. 4J ^� �.1;1,P Cn% 'i(,' <, E <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />7}ipe of Project: _New_Addn _Aiteratlon _Repair <br />Show Number (#) of /ixtures <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 />Ran e hood <br />Exhaust fan <br />Heat ump <br />Unit heater <br />� Boiler <br />Re rigeration <br />Woodstove <br />Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYS' <br />Number of Heads <br />of Project: _New _Addn _Alteration _Repalr <br />Show Number (#) of �xtures <br />I Toilet <br />Kitchen sink & disposa <br />Clothes washer <br />Backflow preventer <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 appllcation and know the same to be true and correct. All provisions af 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 constructio� <br />That I am authorized by the owner of this property to peAorm the work for which application is made and I compiy with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�r <br />�� �'•3 j l �� <br />Owned thorize Agent Signat re ate (Revised 3i2013) <br />,� <br />