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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 />ITE ADDRESS: .� � y, ' � , IPROP <br />� �_. ; f�-f �-�- � ��' ._ f _ -- �, ��- i � /�i />O <br />LEGAL for new construction: Short PlaUsubdivisi <br />AX� PE IT # <br />) �, ; %i �: ,� � �,� j �c� t� �,�j � `'� � � ' C� <br />Lot No. (attach copy of long legal description) <br />WNER E' ��/��� Q�J�/��/,) v/ Q/c•/ �' Phone/E-mail /Z,�� -5�,� , � � � <br />jdress 3/� � �Q�,U r /`1(�� � City/State/Zip �/���� � <br />PPUCANT: �Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant �musc Provide a iener ot consent rrom �ne owner �o do work in �ne space� <br />NTRACTOR <br />ESS <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Phone/Email <br />Bus. Lic. # <br />CONTACT FOR PERMIT �? r r'�� <br />��� �� . � �- <br />Phone/E-mail 7.G.�JO� F.��(} �L��/������/�• ���7 <br />CONTRACT PRICE OF WORK ✓-'Y 1�� � t) <br />Existing Use of Building <br />Proposed Use of Building Ga <br />Building type: _ Single Family __;_, Duplex'_Townhousef; ,� ��,amily _ Commercial <br />Type of project: _ New _ Addition ' Remodel �Repair _ T.I. _ Sign Sprinkler C <br />DESCRIPTION OF WORK (additional space provided on the back : <br />��-�'�/��� /� ���/�;�� �`}t/ ���'%,�i✓�� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />� Forced air systems <br />j Gas piping <br />i Water heater <br />� Gas fireplace <br />I Gas ranae <br />�iotnes pryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />ChanQe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteretion _,Repair <br />Show Number (#) of fixtures <br />I Toilet <br />; Bathtub <br />� Lavatory (wash basin) <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/i <br />Backflow preventE <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 consiruction <br />That I am ut rized by the owner of this property to periorm the work Tor which application is made and I comply with the State Contractors Law 1827 RCW and 296.200A WAC. <br />� ll� <br />� 1���/�' . <br />Owner/Au ri d Agent Signature Date (Revrsed 3/2013) <br />