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� <br />PE�I►�IT APPLIG/�TIOR! <br />� <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRI(VKLER/DEMOLITI�ON <br />CITY OF EVERETT PERMII" SERVICES Pi�Uq-L���1 <br />3200 Cedar St., Everett, WA 98201 425-257-8810 F,4X 425-257-8557 www.everettwa.org <br />SITE ADDRESG• ,(� <br />� � � �d�/ `/G� J � _•�' <br />for new construction: Short Plat�subdivision <br />��.�{''� !% �D L/� /f�� .�L�. <br />ress �� ��� ��� <br />IPROPFRTY TAX # <br />��La�r3C��c)�'�t�c) j�S� F������ � � <br />Lot No. (attach copy of long legal description) <br />.� _ <br />Phone/E-mail ��, ���__ �� �, � <br />CitylS;ate/Zip ������ ����� ����� �� <br />PLICANT: �Obmer _ Ownef's Agent _ Contractor _ Contr2ctor's Agent _ Tenant (mustprovide a lener ofconsentfrom the owner to do work in tne <br />NTRACTOR ��%,`,f State Lic. � City Bus. Lic. � <br />Address <br />TENANT BUSINESS NAME <br />��i I����/ ����/ <br />BUILDI(dG PEiiMIT APPLICATIUN <br />I Phone/Email <br />TACT FOR PERMIT����� � /�; z,r� <br />�/ �Y f <br />:/E-mail IL�S . �L�O'�: �.J� �� �����r"' ��O/7l-9� <br />CONTRACT PRICE OF WORK ��.5 . Crp <br />Existing Use of Building ��jl <br />Proposed Use of Building <br />Building type: �ingle Family _ Duplex _Townhouse _ Multi-Family <br />Type of project: _ New _ Addition _ Remodel V Repair _ T.I. <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />[� ! �t'�/Y� �' <'!��! �C Oc- ������ � <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handlin units <br />Forced air systems <br />Gas piping <br />� Water heater <br />� Gas fireplace <br />_� Gas range <br />Clothes dryer <br />� Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refri eration <br />Woodstove <br />_ Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SGURCE: <br />Gas Electric �Other <br />_ Commercial <br />�ign _Sprinkler Demolition Change of Use <br />PLUMBING PERMLT APPLtCAT10Nl <br />ofProject: _New_Addn _Alteration_Repair <br />Show Number (#) of fixtures <br />I Toilet <br />� Bathtub <br />Lavatory (wash basi <br />Shower <br />Kitchen sink & dispc <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mc <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 cert'dy lhat I have read and examined this application and know the same to be true and corred. All provisions of laws and ordinances goveming this type of work wili be compl <br />�-ith whether speciBed 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 />Tfiat 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 1B.27 RCW and 296.200A WAC. <br />' � /'�. �-�.� <br />Uwner/Auth z, Agent Signature Date (Revised 9/2014) <br />