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• • <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everetta WA 98201 _ 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ADDRESS: �3Q{) (,(��S <br />0 <br />LEGAL for new construction: Short Plat/subdivision <br />OWNER �/,( t (JL11��a✓� ���(.Q,S <br />Address `��o �!�{✓�.-s�(s V✓• �� �� <br />APPLICANT: _ Owner _ Owner's Agent `�4Contractor <br />CONTRACTOR L�L� l/�'1� I.AVIS� � <br />li <br />s�oo � d� 3 a� � P� i� i�"�� <br />No. (attach copy of long legal description) <br />Phone/E-mail �Q �0 3v`�' 6 � � � <br />CitylState/Zip S �'����� ��� � � 6 � �.° <br />Contractor's Agent <br />State Lic. # <br />T2�8fl1 (must provide a letter of consent from the owner to do v„ork in the space) <br />Phone/Email <br />City Bus. Lic. # <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building ��G� �� � n� �� HEA� SOURCE: <br />Proposed Use of Buiiding !V o �N � N C� � Gas � Eiectric_ other_ <br />Building type: _ Single Family _ Duplex _Townhous� _ Multi-Family _ Commercial <br />T pe of pro ect: New Addition Remodel �yRe air T.I. Si n S rinkler Demolition_Chan e of Use <br />p •�`r S��tL' � I <br />DESCRIPTION OF WORK (additional s ace provided on the back) : �►ei.�—�� �� � I.o u ��'� �� <br />t,�o��� ��9c�1��� S►��N� ���l.�f.�v��a�i ���vA3� p�=�� ������s s <br />��N�oa� 9�a� �ou, � ���n�d1�l� ��s�� f�9 . ����s����� �� ��d� <br />.��-�� �� ���� �� � �-sS �` <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn _Alteration _Repair <br />Show Number # of fixtures <br />A/C — air handling units <br />Forced air s stems <br />Gas pipinq <br />Water heater <br />Gas fireplace <br />i Gas range <br />; Clothes dr er <br />Ran e hood <br />Exhaustfan <br />Heat um <br />I Unit heater <br />� Boiler <br />1. Woodstove <br />' Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Shower <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/ <br />Backflow preventF <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />i <br />r <br />I hereby certify that I have read and examined this ap�lication and know the same to be true and correct. All provisions of laws and ordinances goveming this type of work will be comp <br />with whether specified herein or not. The granting of a permit does not presume to give authority lo violate or cancel the provision of any other state or local law regulaling construction <br />That I am au orized by the owner o s property to perform lhe work for which application is made and I comply with the Stale Contractors Law 18.27 RCW and 296200A WAC. <br />�-�� �� � f �L <br />Owner/Authorized Agent Signature Date (Revised 4/2015) <br />�� <br />