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� AT � <br />r�ERMIT APPLIC 10 <br />BUILDING MECHANICA /PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />N\\G�;:L _r��� (.- <br />SITEADDRESS: � x OZ S� �F�T-r ��Q{,L ,�1�ROPE�RTYTAX# <br />�t (i(/ C( �—(� <br />PERMIT # <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long le�al description) <br />�WNER ��1�{�rC,p V�i ((.l7 Wl[J6S — ��J (Z,(�S"�� 1't N Pho�-mail G�j2• '�j�O•7iOgj T�•l�j `O c.�JI�U 11.�1V� .c <br />�dress �'> �C� � �\ f �, �j't� � ia�� City/State/Zip (Vt � f�( l`� (�(,� �'j M (� • '�j 'ri �'� <br />PPLICANT: _ Owner � Owner's Agent _ Contractor _ Contractor�5 AgEl1t _ Te(12f11 (must provide a le�ter of consent from the owner to do work in the space) <br />CONTRACTOR � 13. <br />� .�¢�t� (,l) ll.� f1,� �`N�S <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />Bus. Lic. # <br />)NTACT FOR PERMIT �g��-a ��,�� C�� <br />one/E-mail � � 2• � a 3� 28 V'O��OC <br />)NTRACT PRICE OF WORK ^' ������� <br />Existing Use of Building �M�i�.(�- '' ��''�� HEATSOURCE: <br />Proposed Use of Building �� ���" ��'���i`�"�'� 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) : Q �/') L� � l�� <br />�"�c1o��iT t rv�, Q�oY�M �t-' - Ca T� sT�J GT' t� ���- w -��' <br />��l c ST ��L , l t�LS`1�cC.,(..1[�5 ��--L L`�-�� t��//� v f`�t 1-� i�t� .��`1 S� pc <br />�c.t� '��c.-��'o lresut�ts � � �s- �.sc��t�� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />� Forced air systems <br />(,p i Gas piping <br />1 � Water heater <br />l � Gas range <br />� Clothes dryer <br />Range hood <br />,3 Exhaust fan <br />Heat pump <br />Unit heater <br />, Boiler <br />i Refrigeration <br />Woodstove <br />3�'j Ducting <br />2 � Other �.'t"fa G�- ` <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />i Toilet <br />� Bathtub <br />j Lavatory (wash basin) <br />� Shower <br />; Kitchen sink & disposal <br />i Dishwasher <br />� Clothes washer <br />� Water heater <br />Sink (service/bar/mop/etc.) <br />� Backflow preventer <br />� Urinal <br />j Drinking Fountain <br />j Floor drain <br />Grease trap <br />� Roof drains <br />� Medical Gas <br />� Other: <br />� Other: <br />� - %/��', <br />� .� <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 ranting of a permit does not presume to. give authority to violate or cancel the provision of any other siate or local law regulating construction <br />That I am authorized by the own of i pro rty to perform the work for which application is made and I comply with the State Contreclors Law 18.27 RCW and 296.200A WAC. <br />/ 3w�l�, ���, <br />OwnerlAuthorized Agent 5igna re Date (Revised 3/2013) <br />