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! <br />C� <br />PE�I�IT APPLIG/�TIO�I <br />BUILDIfVG/MECHANICAL/PLUM�ING/SIGN/SPRIN�CLER/DEMOLITION <br />C1TY OF EVERETT PERMI�' SERVICES ����_� _ ��i, <br />3200 Cedar St., Everett, WA 98201 425-257-8810 F,4X 425-257-8857 wwv✓.everettwa.org <br />SITE ADDRES�: <br />l. sE" #,� <br />LEGAL for new construction: Short PlaUsubdivis <br />C�WNER ��E�iPt�/T �GL��//"�C�.� <br />Address �� ���a f� <br />PROPERTY TAX # PERMIT � <br />U�y�G���i � ���;cSJ /1/) I�11 —C�? Z <br />� Lot No. (attach copy of long legal description) <br />V��/�// � �� Z � <br />� ,/'/ Phone/E-mail J�. L,j fj . <br />� City/State7Zip �v��� `� ���t, ����� � <br />/aPPL�CAi`:T: ✓ Owf1e� _ OWnBf�S AgE�f _ Contf2CtOf _ COntfaCtOf S Agent _ T2f1af1t (muslprovide a letter ofconsentfrom the ow+.er to dowork in the space) <br />CONTRACTOR ���� State Lic. # City Bus. Lic. # <br />%����f%`���2.� <br />BUILDIIdG P�RMIT APPLICATIUN <br />Existing Use of Building J, <br />�Phone/Email <br />CONTACT FOR PERMIT���� � /�: �r� <br />� �1� f <br />Phone/E-mail I��S. ���% �•�J �� �`Q�%1%������ El� <br />CONTRACT PRICE OF WORK ��C,7; �� <br />HEAT SGURCE: <br />Proposed Use of Building � <br />Building type: _ Single Family _ Duplex _Townhouse � ulti-Family _ Commercial <br />Type of project: _ New Addition Remodel �Repair T.I. Sign Sprinkler <br />DESCRIPTfON OF WORF4 (additional space provided on the backJ : <br />C, P.�N�� �' l�/t'! T�O<- �l ����� � <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show NumBer (#) of fixtures <br />A/C — air handlinq units <br />Forced air systems <br />� Gas piping <br />� Wafer heater <br />� Gas fireplace <br />� Gas ran e <br />� Clothes dryer <br />� Range hood <br />� Exhaustfan <br />_ Heat pump <br />� Unit heater <br />Boiler <br />� Refriqeration <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Gas <br />Dem <br />Othe <br />of Use <br />PWMBING PERMST APPLtCATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />Toilet <br />Bathtub <br />Shower <br />Kitchen sink & disp <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/m <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 that 1 have read and examined this application and know the same to be true and correct. AII provisions of laws and ordinances goveming this type of work will be compl <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 construcfion <br />Tliat I a ori by t wner 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 />' �� � � �'�,/ <br />Uwner/Auth z- Agent Signature Date (Revised 9/20i4J <br />