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��R�I� ���������� <br />�111LDIN�/fVIE�H�4NICa4L/PL�M�ItVC/SIG�I/SPR1�91�L.ER/DE11110L,IT'ION <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: <br />�}�i6 SE �v�e��-+-� N��lt �vc <br />�L for new construction: Short PlaUsubdivision <br />ER �r�n� I��m <br />�S �-� �iZ � lf�S �����1,) IvlUtk `I-���� � <br />.ICANT: ✓ Owner _ Owner's Agent _ Contractor <br />���i Mi� l� <br />ress <br />K�S� {�Ut 1-� <br />BUILDING PERMIT APPLICATION <br />� PROPERIYTAX# RM � <br />� � ° r� ��L t�� � b� - ����j, <br />Lot No. (attach copy of Ibng legal description) <br />Phone/E-mail � a-�'—O U`�� � S 7� <br />City/State/Zip � �L 7� <br />_ COfltfaCtOf'S Ag@flt _ Tef18�t (must provida a lelter of cpnsent irom the owner �o dp work In Ihe space) <br />State Lic. # <br />City Bus. Lic. # <br />IPhone/Email <br />)NTACT FQR PERMIT <br />L��- �11-i-' �:��.1� <br />one/E-mail <br />)NTRACT PRICE OF WORK �I � � <br />Existing Use of Building � <br />Proposed Use of Building ���ro �i'r[�11r <br />Building type: ^ Single Family _ Quplex _Townhouse _ Multi-Family ,_ Commercial <br />Type of project: New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkle <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />HEAT SOURCE; <br />Electric Other <br />of Use <br />�,�� S� c�11o���D U� � L��k , G��c1 {�; � C o�n � r' �s u �' � <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATI <br />of Project: _New _Addn _Aiteration _Repair Type of Project: ^New _Addn ,_,_,Alteration _Repair <br />Show Number (#) of fixfures Show Number (#) of fixfures <br />A/C — air handling units Toilet <br />Forced air systems Bathtub <br />r_�� .,�„�„� Lavatorv (wash basin) <br />vvater neater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />� Other <br />SPRINKL.ER / SUPPfZESS10N Sl(STEM <br />Number of Heads <br />hower <br />Dishwa <br />Clothe� <br />Water f <br />Ba <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.grarriTng pY a permit does not presume to give authority to violate or cancel ihe provision of any other state or local law regulating consiruclion <br />That I am ayikioriz�d by the owner of this prop to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.20oA WAC. <br />J , �\ �' � ti'� �-' � �� � � Z�� � � <br />� ' �: <br />Ownc�r/Authorize gent 5ignature Date (Revised 4/2015) <br />11L <br />