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�► s <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 />SITE ADDRESS: PROPERTY TAX # PERMIT # <br />�I �� ��u[Kc � i�v4:. C�I - � % <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER �7 (,�y j � N � ' �-) Phone/E-mail � U�, � �(-U �Z(�S � <br />Address CitylState/Zip <br />APPLICANT: �Owner _ Owner's Agent _ Contractor _ Contractor�5 A9eflt _ Tef18111 (must provide a letler of conseM irom the owner to do worK in the space) <br />CONTRACTOR ` '' .;. 4 •%(,.J State Lic. # � 1�-� � N %� (( �-�^i�Cj City Bus. Lic. # '—Y�,C�'Lkl� � �� <br />Address Phone/Email '��,n -. ��� __ �C�'� � � <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK CC�% <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 (additiona/ space provided on the back): <br />� Di� 11�1 L� 'Ti.) �-��71/� l� �,�'1,�G �'�:.�Y1'1(C� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New ✓ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show Number (#) of fixtures <br />� A/C — air handling units � Toilet <br />� Forced air systems � Bathtub <br />; Gas piping � Lavatory (wash basin) <br />� Water heater ; Shower <br />Gas fireplace i Kitchen sink & disposal <br />� Gas range i Dishwasher <br />! Clothes dryer Clothes washer <br />j Range hood ; Water heater <br />� Exhaust fan � Sink (service/bar/mop/etc.) <br />j Heat pump j Backflow preventer <br />; Unit heater Urinal <br />': Boiler Drinking Fountain <br />� Refrigeration Floor drain <br />Woodstove ! Grease trap <br />✓ Ducting ; Roof drains <br />� Other ; Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM I Other: <br />Number of Heads � 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 />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18,27 RC W and 296.200A WAC. <br />��,���c��-- �- ,/ �� <br />Owner/A horized Agent Signature Date (Revised 3/2013) <br />