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� � <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 />ADDRESS: <br />:� L��! I�L S� �t��E�i l u��l <br />� <br />1L for new construction: Short PlaUsubdivision <br />ER J�FF�w �. <br />PPLICANT: � Owner <br />R <br />PROPERTY TAX # <br />P <br />No. (attach copy of long legal description) <br />Phone/E-mail �{�rj�L�� — <br />City/State/Zip ��.�� <br />Owner's Agent _ Contractor _ Contractor�S Ag2fll _ T@fl8flt (must provide a letter of consent from the owner to do work in the space) <br />�� <br />State Lic. # <br />j��� �Phone/Email <br />NTACT FOR PERMIT <br />S�DT City Bus. Lic. # <br />- i 575 !-!�`�C � <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1(� �7� �' <br />Existing Use of Building 5�1� HEAT SOURCE: <br />Proposed Use of Building .5{'"(� Gas_ Electric_ Other <br />Building type: `� Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition ✓ Remodel Repair T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (addifional space provided on the back) : <br />�e-rC70� <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />I. Forced air systems <br />; Gas piping <br />i Water heater <br />� Gas fireplace <br />� Gas ranae <br />c;lotnes aryer <br />Range hood <br />Exhaust fan <br />Unit heater <br />Boiler <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Bathtub <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dispo� <br />Dishwasher <br />Clothes washer <br />Water heater <br />Backflow prevent� <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 />Thai 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 />\. . c� �� � �. <br />Ow er hor' ed Agent Si at e Date (Revised 3/2013) <br />