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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: <br />� ��n. i,� l;� �--f r�, � �'�� <br />PROPERTY T <br />:�C�� �F <br />LEGAL for new construction: Short Plat/subdivision Lot No <br />OWNER ,I� � � %/}'1 -v � 7 ' %1 Phone/E-mail <br />.� .� <br />Address 7�`� i iifj��% �"�✓�„t;�� '��/ City/State/Zip� <br />CANT:'� Owner <br />CONTRACTOR <br />ress <br />G/�� <br />(attach copy of long legal description) <br />� �,� ��S _� <br />;-�P �/ ��'i G' � <br />Owner's Agent _ Contractor _ Contractor�S A98f1Y _ T0f18f1t (must provide a lette� ot consent from the owner to do work in the space) <br />State Lic. # <br />Phone/Email <br />e/E-mail L� ��/'r� vY <br />Bus. Lic. # <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK M��-�1 :�(.s?U`r� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric_ Other_ <br />Building type: � Single Family _ Dupl x_Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition � Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />i Forced air systems <br />i Gas piping <br />i Water heater <br />� Gas fireplace <br />� Gas range <br />! Clothes dryer <br />� Range hood <br />Exhaust fan <br />� Heat pump <br />Unit heater <br />Woodstove <br />Ducting <br />� Other <br />PRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� � Toilet <br />r I Bathtub <br />C <br />h <br />i j Shower <br />/ � Kitchen sink & dis <br />Dishwasher <br />; Clothes washer <br />; Water heater <br />i Sink (service/bar/ <br />I Backflow preventf <br />Urinal <br />Drinking Fountain <br />Floor drain <br />� Grease trap <br />; Roof drains <br />; Medical Gas <br />' Other: <br />i 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 slate or local law regulating construction <br />That I am authorized by the owner of this property to peRorm the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br />� '''� ,: - - �� �' �7 <br />l�/ " / O� /�C./ <br />Own Authorize Agent Signature D�Se' (Revised 3/2013) <br />