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� <br />� <br />� PERMIT �PPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />! CITY O� EVERETT P�RMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8$57 www.everetEwa.org <br />for new constructEpn; Shott Platle <br />�R <br />;ss ���� <br />LICAN7: _ owner _ ownera qyent <br />CONTR{�C70R <br />dress <br />�� <br />�ot No- (attaCh copy of long legal description) <br />AMone/E-mail �a �, � . -�j a _ ���� � <br />� Q�� <br />Contrsc(or ` ContraCtor's Agent � Ten�nt (rn�at pro��de � letter af consenl from Ihe avmer to do work in thc sp <br />y��� State Lic. #��,y� �}�q„Q"�-� � City �us. Lic. # b oi � p( <br />1L,DING PERMIT APPLICATIQN <br />�,� lPhonQ/Emyi) <br />CQNTACi FOR PERMIT <br />Fhone/E-me31 + Q„� YYi i {� <br />CONTRACT PRICE OF WOi2K <br />m «. <br />Existing Use of Buflding , HEAT S4URC�: <br />Proposed Use of 8uiiding Gas E�ectric othar <br />L'uilding type: _ Single Family _ buplex �TownhoUse _ Multi-Family � Comm�rCi�l <br />7 e of ro"ect: New Additlqn Remodel Rep�ir T,i, Si n H r kler Demnlitlort Chan e o� Use <br />D� RIPTIOf1i OF WORF�(additiona! s ce provitletl on fhe eck) : C�- <br />'� a� 4� �-�. � c s.�-� }'�' C� Q S r►'�A <br />MECH,YNICAL PERMIT <br />Type of ProJeCt: _New _Addn �11teYstion ` <br />ShowNumbel #'Of11Xtu!'es <br />A/C - air handlin unl(S <br />Forced air s stams <br />Gas i in <br />Water heat��- <br />Gas ran e <br />Cfothes dryer <br />Ran e hood <br />Exhaustfan <br />Haat um <br />Unit heater <br />8oiler <br />Refrigeration <br />Woodsto�e <br />Ductin <br />Other <br />SPRINKLER 1 SUPPRESSI <br />Number of Heads <br />,TION � � P�UIWBlNG PERMIT APPLICATION <br />Type of PPoJect: _New _Addn _Alteration _i2epair <br />Show Number (ijJ of fiXtures <br />� Toilet <br />� Bathtub <br />isnor <br />s washer <br />heater <br />Drinking Fc <br />Floor drain <br />Raof dreing <br />Medic2l G9s <br />Other: <br />Other: <br />f hereby certify that I have resd �nd exeminsd 1h�s aDD��etion and know the same to ba uue antl correct. Alf provisions af laws antl orrilnancea goveming lhis iyps of work w�l bs comD <br />! wh�thsr speclRed hsraln ar not. The granling of a perm�t does nat vr�sume to p've authoriry to vlolete or cancs! the proviaion of any other slats or ioCal law regulaung consVuaton <br />7ha I �m �ulhonzad by the own r of Ihls property �o perfnrm #hs work for hich av�li ation � made and I comply with the SFate Conirectors �aw 18,27 RCW and 296.200A WAC. <br />� � � <br />nc�/Autf� rizetl Ag9nt Signatura ste � (Reviseo� 9/2014) <br />�� ���� <br />� <br />