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� <br />• <br />` PERMIT APPLICATION <br />BUILDING/ME�HANl�GAL/PLUMBIN�/Sl�N/SPRlNKLER/DEM�l�ITI�RI <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 />SIT� ADDRESS: PROPERN TAX # MIT # <br />a s�� n � � ,��. . ,� _ _ a ��i � r,� _ nr�� <br />GAL for new construction: Short PlaUsubdivision <br />V(3TL /iartin e o�.+� �,..�.- S �-SS o ��.�.�-� �a vi <br />VN E R C_�o l�t�C P I�r S o�� S �rosJ.�u� �k, M4va <br />iress ��"J��J� %%Fi g� 5�' ,S4t.��'�- �vU <br />PUCANT: _ Owner �Owner's Agent _ Contractor _ <br />�NTRACTOR (l�►CLGoG{ �nS'�u-�'�io�n <br />i�ess II15 nl IlfO� Sfi. S[a+Fl.� <br />TE <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail �{j�5.7�17�5�1W /'��N��.�y�,��o <br />City/State/Zip <br />% [d7 OC��j <br />Contfactof S Ageflf _ TBfl2fll (must provide a letter of consent from the owner to do work in the space) <br />`C L& I Lic. # � �OCLq�JI D COE Bus. Lic. # <br />��., Phone/Email 2�. 5+{6. �87'j <br />CONTACT FOR PERMIT �J�m �/ �J Z[oNs�,,� ��q,v�s. <br />Phone/E-mail ��-�• 2�13• 1'��i2 <br />BUILDING RERMIT APPLICATION CONTRACT PRICE OF WORK �'(!J, Z3) •'�S <br />Existing Use of Building �i6�i�'( e�r`�:'dJi�j�' �',�'d��l�.�`Z HEAT SOURCE: <br />Proposed Use of Building �/ca ��d: ��� Gas_ Electric <br />Building type: _ Single Family _ Duplex _Townhouse r�' Multi-Family _ Commercial <br />Type of project: New _ Addition Remodel �Repair _ T.I. _ Sign _Sprinkler _Demolition_ChangE <br />DESCRIPTION OF WORK (additional space provided on the back): <br />l��/�,� a ��. t,�-tr � r�. ��. � / D T.��"� c'� �' �,�- a �:` � �S`w <br />r` � � �'�' �� i�' �-`� �m �. �" t $ �a!f'a"i P Pr °��' �,� �'F�c�A�':-�� ����t�,>: <br />MECHANICAL PERMIT APPLICATION <br />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 />� Exhaustfan <br />� Heat pump <br />� Unit heater <br />� Refrigeration <br />� Woodstove <br />� Ducting <br />� Other <br />SPRINKLER / SUPPRESS <br />� Number of Heads <br />Other <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 & disposal <br />� Dishwasher <br />� Clothes washer <br />� Water heater <br />I Sink (service/bar/moo/etc.l <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 true and cortect. 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 authority to viotate 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 296.200A WAC. <br />�� � 2 �2(� , 3 <br />.— <br />Owner Authorized Agent SigPature Date (Revised 6/2012J <br />�% <br />