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� � <br />PERIVIIT APPLICATION <br />BUILDING/ME�HANICAL/PLUIV�BINCISIGNISPRINKLER/DEMOL,ITION <br />, CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />EGAL for new construction: Short PlaUsubdivis <br />OWNER <br />ress �Q ,?� � <br />PROPERTY TAX # <br />��� �� <br />PERMIT # <br />No. (attach copy of Ibng legal description) <br />Phone/E-mail � ( �.,��� — <br />City/State/Zip <br />APPUCANT: Owner _ Owner's Agent �Contractor _ Contractor�5 Age�l _ T@fl2fll (must provide a letter of consent from the owner to dp work in the space) <br />CONTRACTOR � � ( State Lic. # �P� G��� City Bus, Lic. #� I�� �� I <br />Address �� `�/ �( �,3� Phone/Email L-rj �%�� <br />CONTACT FOR PERMIT �� <br />Phone/E-mail -��� �O (O <br />BUILDING PERMIT APPLiCATION CONTRACT PRICE OF WORK� SicI3�O. U� <br />Existing Use of Building ,� �''�'---- HEAT SOURCE: <br />�, <br />Proposed Use of Building :.Z�,$'� � Gas� Electric_ Other_ <br />Building type: �Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (addirional space provided on the back): ���C� �x(S7JN�— �9�1'S +�«�� W�� <br />ft- �,1 e� G�-s �is�P.r/,¢�E T-N ��- �� Lo �A�� � � n�o N2u� �s7t-S �� p� N� � A�vO <br />�s � A�c� A- n/-e� lf..e�-� Gui►�. P- � <br />LI <br />of Project: _New _Addn �Iteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />Forced air systems <br />vvater neatei <br />Gas fireplace <br />Gas range <br />Clothes drye <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriaeration <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 />I Toilet <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />basin <br />r/m o <br />Urinal <br />Drinking Fountain <br />Flaor 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 correct. All provisions of 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 construction <br />hat I am thorized by the owner of this property to perform fhe work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />I 3 �� <br />Owne orized Agent Signat ate (Revised 4/2015) <br />