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• • <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, W(� 98201 425- 57-8810 FAX 425-257-8857 www.everettwa.org <br />����'�' ��� � � 1" li�,� �������'i � <br />ITE ADDRESS: ��Q� �,(%�5 <br />GAL for new construction: Short PlaUsubdivision <br />NNER `Q(,( t �Q1��Q✓� ��� <br />dress ���� �Qi�i�-Slf/�Ps V�� �i• <br />CONTRACTOR <br />� <br />Owner _ Owner's Agent � Contractor <br />� K I'�o� <br />BUILDING PERMIT APPLICATION <br />L.1P� <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail a0 �p 3�9 �/� 3 � <br />City/State/Zip S �=f$��(`�� (,�� � �i B � Z� <br />COf1t!'BCtOf 5 A90flt _ Te�a�t (must provide a letter of consent from the owner to do v.ork in the <br />State Lic. #(/ Q 0��0 ����DY//i�,A City Bus. Lic. # Q�j Z <br />IPhone/Email <br />�R PERMIT <br />✓ W � � J � � <br />PRICE OF WORK IZ � 7 <br />Existing Use of Building ���� 7�� n0 �.S HEA SOURCE: <br />Proposed Use of Building IV o �• Y�/`Y �� Gas_ Electric_ Other_ <br />Building type: _ Single Family _ Duplex _Townhous Multi-Family _ Commercial <br />T pe of pro ect: _ New _ Addition _ Remodel �epair _ T.I. _ Si n_Sprinkler _Demolition sChan e of Use <br />DESCRIPTION OF WORK (additional space provided on the back) :,L�`r S� 1'� G�(L�—�� �� T�� u� �`� �: <br />�o�a� a�C�t��� S��9NG� �����.�a�.� P�����'� p�=��. �-���s�s � <br />�bNfloan� ���— Ro�, � a�FN�,�I� ��s�-I�N . �n��Ws`s���S T� ��� <br />/� �-�� � � � � L� �- � '� S <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 piping <br />) Water heater <br />I Gas fireplace <br />j Gas range <br />� Clothes d er <br />Ranqe hood <br />Exhaust fan <br />Heat pum <br />Unit heater <br />� Boiler <br />Refrigeration <br />! Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#J of fixtures <br />; Toilet <br />Bathtub <br />I I avatorv (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 (inside <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />� <br />r <br />I hereby certify that I have read and examined lhis ap�tlication 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 specifed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other slate or local law regulating construction <br />That I am au orized by the owner o s property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />r- � J <br />/,���U <br />Owner/Authorized Agent Signature Date (Revised 4/2015) <br />��� <br />