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� <br />� <br />PERMIT APPLICATION <br />BUILDING/MEGHANICALIPLUMBIIVG/SIGN/SPRINKLERIDEM�LITION <br />CITY OF EVERETT PERMIT S�RVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: <br />� `J� <br />PERMIT tt <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy oi long legal descripfion) <br />OWNER � � Phone/E-mail <br />Address r � , ��, City/StateiZip �{�- �D <br />APPUCANT: _ Owner _ Owners Agent lt Contractor _ Contractor�5 A jBfl( _ T�fl3fli (must pro�ide a IGttef o( consen! Irom Iho ownafto do.vork in Iha space) <br />CONTRACTOR State Lia �' '(p (_ [� City Bus. Lic. <br />Address �� ��� ^� . Phone/Email yt,�(� [�-�v��� <br />TENANT BUSINESS NAME C NTACT FOR PERMIT �,��� �� � c� <br />._7 <br />PhonelE-maii �j- - 3 C«7'1�'A'CCi.e�� � <br />BUILDING PERMIT APPLICATION CQNTRACT PRICE OF W�RK <br />Existing Use of Building <br />Proposed Use of Building � <br />Building type: � Single Family _ Duplex _Townhouse ____ Multi-Family _ Commercial <br />Type of project: New Addition Remodel _ Repair _ T.I. _ Sign _Sprinkler _ <br />DESCRIPTION QF WORK (additror�al space provided on the back) : <br />�oi l e�' �� 5-4-� (1 c-fi c� <br />MECHANICAL PERMIT APPLICATION <br />Typo of Project: _New_Addn � AI[eration _Repalr <br />Show Numher (#) of (rxtures <br />A/C - air handling units <br />I Forced air systems <br />j Gas piping <br />� Water heater <br />Gas fireplace <br />I Gas range <br />Clothes dryer <br />i Range hood <br />� Gxhaust fan <br />� Heat pump <br />i Unit heater <br />� I Boiler <br />; Refrigeration <br />j Woodstove <br />Ductinq <br />SPRINKLER / SUPPRESSION SYSTEM <br />/1 Number of Heads <br />HEAT SOURCE: <br />on Y Chanpe of Use <br />PLUMBING PERMIT APPLICATION <br />Type ot Project: _New _Addn _Alteration _Repair <br />5how Number (#J o/ fixtures <br />� Toilet <br />Bathtub <br />� Lavatory (wash basin) <br />j Shower <br />� Kitchen sink & disposal <br />j Dishwasher <br />j Clothes washer <br />Water heater <br />� Sink (servicelbar/mop/etc.) <br />; BackfloNi preventer <br />; Urinal <br />� Drinking Fountain <br />j Floor drain <br />Grease trap <br />Roof drains <br />� Medical Gas <br />i Other: <br />I Uther: <br />I hereby cerlify Iha � I have read and examioed this application and knov✓ ihe same to be true and wrrect. All provisions of laws and ordinances governing ihis type of work will be complied <br />wilh whether�spe ified herein or notTThe granting of a permil does not presume to yive aullionly lo violale or cancel the provisiun u( any olher stala or Iocal lavr reyulatiny construction <br />Tha fn-aqi o zed by the mer of thi� propeRy to p�riorm the y.wrk (or which appllcation is made and I compiy with the Sfate Contractors Law 18.27 RCW and 296 200A WAC. <br />, /' ,' / ��,,� " � 1 <br />� , ���� <br />� <br />i Owp r/Authorizod Ag nt' ignatura Date (Revised 3/2013) <br />� <br />