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����.�������a���� <br />��������IV�l��l��af�n�r��./��,���1��/�I��d/������{���/����a��'��I� <br />� C1TY �F E!lERETT P�i�MI�' SERVICE� <br />3200 Cedar St., �verett, WA �8201 425-257-8810 FAX 425-257-8857 www.e�erettwa.org <br />SITE ADDRESS: PROPERTYTAX # PERMIT # <br />� �� � v / � i r '- <br />f�e' � � fJ�ilC�-S' i`�1/� ' � 2 - <br />L�GAL. for new constnuction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER ' qTjf�lZ/n!C �/7T,� Phone/E-mail �,� Z _ � , <br />Address �� �2 % �� �P/� � ✓ � ! { CitylState/Zip �-; (�Y/A ( <br />AFPLICANT: _ Owner � Owner's Ageilt ^ Contfactor _ Contfactor's Age�t _ Tenant (mu5t provrda a lener of �pnsBnt from me owner to dp work In the spa�e) <br />CONTRACT4R �W r��12, State Lic, # City �us. L.ic. # <br />Address � Phone/Email <br />CONTACT FQR PERMIT <br />�Y,`%u01� �/!%s <br />Phone/E-mail �U � 9��• 7 � � <br />m I ;� ✓'' <br />BUILDING PERMIT APPLICATION coNTw�cT PRICE oF vyoRK <br />Existing Use of Building Rc��u�qL HEAT SOURCE: <br />Proposed Use of Building ��'i�r�v/7/9l Gas_ E�ectric ' Dther <br />Building type; ,� Single Family _ Duplex _Townhouse _ Muiti-Family _ Commercial <br />Type of project: _ New _Addition � Remodel _ Repait=T.l. _ Sign _Sprinkler_Demolition Change of Use <br />DESCR1PTlONOFWORK(additionalspaceprovidedontheback): ������ d� f��� ��p�-,,� ��-��,v�,��j�.f' <br />l� �INIS'/�5�. l%�li/t%� �L�-C%j2il'�-G �% lT�n`y!/V��,�C S�'y.l�lT�- "�' PC.��''-fj�NC`Tr�kTv2EJ� <br />. r=i,rlGr/IF,S' <br />�1(�l,"�►��YoJ� {4nu>'c �ykow� DC�'C�i'�ct�8i � CDz D%���v�ci-S <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLl�AT10N <br />Type of Project: ,_New _Addn ,�,Alteration _Repair Type of Project: _,New _Addn ,,�,Alteration _.Repair <br />5how Numker (#) offixtures 5how Number (#) of fixtures <br />A1C — air handling units 3 Toilet <br />Forced air systems 2. Sathtub <br />Gas piping �avafory (wash basin). <br />Water heater Z Sliower <br />Gas fireplace � Kitchen sink & disposal _ <br />Gas range / Dishwasher <br />Clothes drye� Clothes washer <br />Range hood Wate� heater <br />� Exhaust fan ' Sink (servicelbadmop/etc.) <br />Heat pump Backflov� preventer {inside bldg) <br />Unit heater llrinal - . __ <br />� Boiler Drinking Fountain <br />Refrigeration Flqor drain . <br />Woodstove Grease trap , <br />� Ducting � Roof drains <br />� Other Medical Gas <br />SPRIf�I'�[L.�R 1 ��li'�93��S��B�9 ��(�`��M other. . <br />Number of Heads other: . _ <br />� hereby certifyihat I have read and examined ihis appllcation and knowihe same io be true and correct AU provis(ons of laws and ordinances governing ihis type of work will be complied <br />wi{h whe�her specified herein o� not. The graniing of a pe�mit does noi presume to give aufho�ty io violate or cancel �he p�oVision of any other siate or local law �egulati�g conslruclion <br />That I am aut rized by the owner of this properiy to perform the work for which application is made and I comply with ihe State Contractors Law 1 a27 RCW and 296.200A WAC. <br />� � <br />/ � !�: � i <br />/ /".� `��'L,' ��'�. %._. <br />�rierlAuthprized Agent Signature <br />ate (Revised 4/2095) <br />� <br />� <br />