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�PERMIT APPLICATIC�► <br />BUILDiNG/MECHANICAL/PLUMBINGISIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />: ADDRESS: /'y� � f}I � n �7 �, '�-�^ PROPERTYTAX # �ERMIT # <br />t'f���'J Y Y�J S� oos�� 9Z oo/Do vov IlV'� I�1 Q J�1�;� <br />�L for new construction: Short Plat/subdivision Lot No.� (attach copy of long legal description} <br />ER �i����� f�O�r/%��j f%!/T��lj� Phone/E-mail �Z .�T�t7 , 9� Z� <br />Address�4 �QX /��7 ICitylStatelZip ���� ��% 9���� <br />� <br />APPLICANTt,� Owner _ Owner's Agent _ Contractor _ Contractors Agent _ Tenant �m�5� Pro�iae e iaaar o� co�„«,c rrnm u» oN„er m ao ��c in me <br />� <br />�����1�� <br />BUILDING PERMIT APPLICATION <br />State Lic. # f���� ��11(71 Z City Bus. Lic. # <br />Phone/Emaii <br />)R PERMIT �ND Y ��—LT��-- <br />� <br />ONTRACT PRICE OF WORK <br />Existing Use of Buiiding J�i�i� <br />Proposed Use of Buiiding �l�/L � <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition .� Remodel Repair T.I. Siqn Sprinkle <br />DESCRIPTION OF WORK (additional space provided on the 6ack) : <br />����� ��� �i�� <br />� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn Jf Alteratlon _Repair <br />Show Number (#) of fxtures <br />rv�. — an uarn <br />Forced air syt <br />Gas piping <br />Water heater <br />Ciothes drye <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />� Other <br />SPRINKLER / SUPPRESSION <br />�35"6/.3-7�; <br />/60 0, � <br />HEAT SOURCE: <br />� Electric Other <br />:molition Change of Use <br />PLUMBiNG PERMIT APPLICATION <br />ofProject: _New_Addn _Alteration_Repair <br />Show Number (#) of flxtures <br />Toilet <br />Bathtub - <br />Lavatory (wash basin) <br />Shower <br />Backflow prevente <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Medical Gas <br />Other. <br />Other: <br />i here6y certify that I have 2ad and examined thls applfcatfon and know the same to be true and correct. All p�visfons of laws and ordinances goveming this type of woric will be eompl <br />with whether specified herein or not. Tha granting ot a permft does not presume to give authoriry to vfolate or cancet tha provision of any other state or local law regulatlng constructlon <br />T1iat I am authori by the o ner of this property to perform the work for which application Is made and I compy with the State Contractors Law 18.27 RCW and 298.200A WAC. <br />-�-�'-- C' i S , ,5 <br />Owner/Authorized Agent Signature Date <br />(Revised 42015) <br />