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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, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ITE ADDRESS: PROPERTY TAX #i PE MIT #� <br />�'r;��� � i��c l �.�t� ,�-v� ��� , 9���� � �h 4 �'�R -- D l <br />LEGAL for new construction: Short PlaUsubdivisio <br />� � �T, U� � <br />No. (attach copy of long legal description) <br />Phone/E-mail <br />jdress�� �j � � LC�I l� �-C . ICity/State/Zip �'v�. ,� I/-f�il/ij"f� ��/',�U' � <br />PPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�5 A9211► _ T@IlBfll (must provide a letter of consenl trom lhe owner to do work in Ihe space) <br />ONTRACTOR �iC'� � vr.l �� y� State Lic. #�C%� S' �-322 c�ty B�s. ���. #v j 33�;; <br />idress � �0C ��y� �7 �/ ;'r :�'�f- �t��� -4�c� y�c�� Phone/Email ,�d�- yw 3-y� yi <br />ENANT BUSINESS NAME CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building 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 (additional space provided on the back) : , <br />�t� �i' !/ il f� C' � a� �`'c'� �''%��-- �G U�' �' S ��� �%�f 5:�' SLj� c' 1`r ,,,�� . <br />.�'� <br />�f �� C��JlI � U/� 1- �f G�° `�i� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I A/C - air handling units <br />� Forced air systems <br />:' Gas piping <br />i Water heater <br />� Gas fireplace <br />i Gas range <br />! Clothes dryer <br />� Range hood <br />J Exhaust fan <br />Heat pump <br />� Unit heater <br />; Boiler <br />� Refrigeration <br />� Woodstove <br />I Ducting <br />I Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />; Bathtub <br />i Lavatorv (wash basinl <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor 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 lype 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 />That I am authorized by the owner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />riJ�,. __ �� �.—i <br />`L <br />Owner/Authorized ent Signature Date (Revised 3/2013) <br />