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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 />Q s� � w� ���r r�r.�,� i G.� <br />LEGAL for new construction: Short PlaUsubdivision <br />OWNER <br />Address <br />APPLICANT: Owner <br />CONTRACTOR G � <br />TAX # <br /># <br />—ul <br />No. (attach copy of long legal description) <br />Owner's Agent _ Contractor _ Contractor'S A9@flt _ T@f18ni (must provide a letter of consent from the owner to do vrork in the space) <br />0 <br />� 1"� � �i��ti.i-t�.-}u�a�-G <br />Ccw�'iri�S <br />BUILDING PERMIT APPLICATION <br />State Lic. #(� ��%� '�`"/ �jTj� City Bus. Lic. #� 2�1 <br />, 3�- �di/- ST(vN � <br />��L1 �� Phone/Email � � �JG� �ut�-��•^ - ��f <br />CONTACT FOR PERMIT <br />�o� P�p�.-h-. � 5c� - ��.-ss-� �' <br />Phone/E-mail � ��-�,,,� C.i /� � �� , D <br />CONTRACT PRICE OF WORK __ /S .S�iC�' <br />Existing Use of Building <br />Proposed Use of Building Ga <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family �i Commercial <br />Type of project: New Addition Remodel Repair �T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number # of fixtures <br />A/C — air handling units <br />Forced air svstems <br />vas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes drver <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />Electric Other <br />Demolition Chanae of Use <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn Alteration _Repair <br />Show Number (#) fixtures <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8� disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mopletc.; <br />Backflow preventer (inside <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 type of work will be compl <br />wdh 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 auth d by e owner property to perform the work for which application is ma e and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />-'� �5�� / � ��,�� <br />Owne uthorized Agent Signature Date (Revised 4/2015) <br />