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� <br />� <br />PERMIT APPLICAT'ION <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.eye�et�va� �O� �Q <br />p <<-t l�� <br />ITE ADDRESS: PROPERTY TAX # PERMIT # <br />/. o ` ���,� v - <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) 1 <br />WNER �/�f Phone/E-mail G���+c--u�Yr L'� � C-fJ <br />�dress � (, �{ �� � � , CitylState/Zip (,�'"f " f �" <br />PPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�S A9@ilt _ T@naf1l (must provide a letter of consent from the owner to do work in the space) <br />RACTOR ��/r��i7 ��zCf�'�iG��t�'1 �G IState Lic. #$����C=�a�,s'c� City Bus. Lic. # oybL <br />Phone/Email <br />/ � �" � � / C � �a S �- � rtc� $ � Sc.� r►�sc� c� �c�.,, (��c�-�v�► <br />� � � Phone/E-mail `'Ld+'� <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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. Siqn Sprinkler Demolition Chanqe of Use <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 handlin units <br />Forced air s stems <br />Gas piping <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes d er <br />Ranqe hood <br />Heat pump <br />Unit heater <br />Boiler <br />Woodstove <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn �Alteration _Repair <br />Show Number (#) of fixiures <br />� Toilet <br />Bathtub <br />Lavatorv (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <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 thal I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing lhis type of work will be compl <br />with whelher specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other slate or local law regulating construction <br />That I am a d by the own r 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 />I <br />c �, ��-�7- s� <br />Owner/Authorized Agent Signature Date (Revised 9/2014) <br />