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• <br />C� <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� PRQ E T TAX P RMIT <br />:3��r N�ss v s7 �<-. =�-� ���;�� ��%� ���� �1 � � �% � 7c �� � , , ;�' <br />LEGAL for new construction: Short PlaUsubdivision Lot No._ Y',s (attach copy of long legal description) <br />OWNER /%/uStr�C� �c-.�✓1r1 �'��<'/o yy9r.a't` �� Phone/E-mail 'iu2,5.�t/�i"C�,�/C� c;/�+.�(«�J�•,-`�„ — u.:o�s rA�'7 <br />�dress �C� �;j O y( <br />PPLICANT: �C Owner . <br />ONTRACTOR ��c <br />� <br />idress �o.._.,,-. <br />�;� � City/State/Zip ; 1 �(—(�F-' � �,� � �7 ��j � �� <br />Owner's Agent _ Contractor _ Contractor�S A je�f _ TEnaflt (must provide a letter of consent from the owner lo do work in the space) <br />BUILDING PERMIT APPLIGATION <br />State Lic. # <br />Phone/Email <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building 5 JtiJGC<`_ �LkM(<Y ��-S��F�/C.E <br />Building type: �ingle Family _ Duplex _Townhouse _ Multi-Family <br />Type of project: x New Addition Remodel Repair _ T.I. <br />DESCRIPTION OF WORK (additiona/ space provided on the back) : <br />(� `' ��� <br />�cv✓�� r•��c--������? r3 } c� iJlc�'. ..� <br />�3c�s � � <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: �New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />j I Forced air systems <br />�.� i Gas piping <br />� i Water heater <br />� Gas fireplace <br />f I Gas range <br />1 . Clothes drver <br />t Exhaust fan <br />� Heat pump <br />i Unit heater <br />! Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />� Other <br />I <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Commercial <br />'�3� <br />City Bus. Lic. # <br />HEAT SOURCE: <br />Electric Other <br />molition Chanpe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: /�New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />.� ! Bathtub <br />� i Lavatory (wash basin) <br />I Shower <br />j Kitchen sink & disposal <br />� Dishwasher <br />/ ; Clothes washer <br />Sink (service/bar/m <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 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 RCW and 296.200A WAC. <br />�"— L <br />� �'�. � /� � �� <br />Owner/ uthorized Agent Signature Date (Revised 3/2013) <br />