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� � <br />PERMIT APPLICATION <br />Bl11LDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />320Q Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE �p�2 ��..�1� � �� <br />�� <br />LEGAL for new construction: Short PlaVsubdivision <br />OWNER V���'i' VV(�(,,��✓\ <br />idress � ��3 � <br />PPLICANT: Owner <br />NTRACTOR <br />fP.SS � �� <br />��` SI - S� <br />_ Owner's Agent � Contractor <br />� �nG� �e �nC • <br />� 2'� %�—� . <br />BUILDING PERMIT APPLICATION <br />T: n?�'i� <br />Lot No. (attach copy of long legal description) <br />PhonelE-mail �� � L��' (s C/� <br />City/State/Zi�v��� ��- � �Z <br />Contractor�5 Ageflt _ T0f1811t (must provide a letter of consent from the owner to do work in the space) <br />State Lic. LC � (D l. � City Bus. Lic. #Z�Z(o ��/ <br />Phone/Email�E'/L, ��W 1.,— <br />Phone/E-mail ����'�V�1 �C�cl ��� � ��� <br />CONTl2ACT PRICE OF WURK fl#� � U I���gs <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 projec� New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition '�Change of Use <br />DESCRIPTION OF WORK (addition space provided on the back) : <br />0('e \G�C� � S�� 1Y�S-�l. � � . <br />� �0 � <br />_ �, �, -�,Y.� I �r-Q- `�- �n1G�-+� ✓ 0(1���+�'�- �v�►� � <br />C-�as � � <br />MECHAN L PERMIT 14PPLICATION PLUiVIBING PEFtMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: lNew _Addn _Alteration _Repair <br />Show Number (#) of fixtures Show IYumber (#) of iixtures <br />� A/C — air handling units � Toilet <br />�-� I Forced air svstems f ! Bathtub <br />uly� ; ( Gas pipin ,J <br />� ; r eater <br />� Gas fireplace <br />i Gas range <br />� Clothes dryer <br />Range hood <br />—� Exhaust fan <br />Heat pump <br />J Unit heater <br />! Boiler <br />; Refrigeration <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESS <br />� Number of Heads <br />ION SYSTEM <br />j Lavatory (wash basin) <br />i Shower <br />; Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />; Sink (service/bar/mop/etc.) <br />; Backflow preventer <br />Urinal <br />I Drinking Fountain <br />; Floor drain <br />Grease trao <br />Medical Gas <br />Other: <br />Other: <br />I hereby certif� that 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 wheth �specif ed 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 m aut�ho 'z d by own of thi property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� ?��� � � � <br />nature Date (Revised 3/2013) <br />