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�ERMIT APPLICATI� <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 />iITE ADDRESS• / --- PROPERTY TAX # <br />=,,1� � f/' ��,^"'�j//�/� '�F �' tT,ri�� �.��% C3c7�t`6�!7�'i7/�' ()U <br />PERMIT # <br />9 <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />�WNER E' U�/C�� Q!/S�/��(,� v� � �/.,-r•, Phone/E-mail /��G �J ' � L � <br />�dress �/v � [�Q� ,�� �i(�� � City/State/Zip �v���� � <br />PPLICANT: V Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �m�st Pro�ide a iener ot �onsen� rrom me owner io ao wonc in che sPace� <br />CONTRACTOR <br />T BUSINESS <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building <br />Lic. # <br />Bus. Lic. # <br />� Phone/Email <br />:ONTACT FOR PERMIT��� N� � ,£, "" <br />hone/E-mail 7 Z�`J L7p : 6.-3/ c.� �CS/(�/�/<.�' ��%/�/'9� d/��"� <br />;ONTRACT PRICE OF WORK 5�3 f'/, � <br />HEAT SOURCE: <br />Proposed Use of Building � Gas Electric � Other <br />Building type: _ Singie Family _ Duplex _Townhouse _ Muiti-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 />s�',�j'�/��s r/'.,�'/';r � �Sr/� �,�/'�-��'���r /�/,��f� �fi���'���,�'�--` <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />A/C — air handling units <br />� Forced air svstems <br />SPRINK <br />Water heater <br />Gas fireplace <br />Gas ranae <br />Clothes dryer <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />Other <br />� SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />� Toilet <br />� Bathtub <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & dispos <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/moF <br />Backflow preventer <br />Urinai <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 granling of a permit does not presume ta give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am ut rized 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 />- - „S� �' ��Z ; <br />� � <br />Owner/Au ri d Agent Signature Date (Revised 3/2013) <br />