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� ��I� ����Q�����n�a <br /> �111L�ING/N1E�HAfVICeAL/PL�JiV�61fVG/SIGN/SPRIf�KLER/DE1�1�L�ITION <br /> CITY OF EVERETT PERIVIIT' SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# P RMIT# <br /> o� 22 �-�t�n -Ave �5� �rer�t� 1�ft RB�oa' .� 3��-o�o 0 0 � 0 3 G�'00 <br /> L�GAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER 5'�!J�- �V�VGS-�—n.�R�t Phone/E-mail 3�� �d3-g��1 S `cu,ti��ccdGN� �eu.w.�►�t'�� <br /> Address 12'�p'� 14-�-t,� �� s� City/State/Zip �V�..Y�2.-�-� �,� �$�� <br /> APPLICANT:�Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant�must Provide a ieuer or�onsent from cne owner io aP work in ihe space) <br /> CONTRACTOR u� State Lic,# City Bus. Lic. # <br /> Address Phone/Email <br /> CONTACT FQR PERM T <br /> Phone/E-mail c� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other <br /> Building type: ,_Single 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 /> �..LQ.t.t�..0�i�-1'�9 n c9� -P.�c,�d N't.�-.�Q l.t,m�.r.� <br /> ll <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _,New_Addn ,_,Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes drye� Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> � Boiler Drinking Fountain <br /> Refrigeration Flaor drain <br /> Woodstove Grease trap <br /> I Ducting � Roof drains <br /> � Other Medical Gas <br /> SPRIRIKLER / SUPPRESSIOtd SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify thai I have read and examined this application and know ihe same to be true and correct.All provisions of laws and ordinances governing this lype of work will be complied <br /> wilh whether specified herei r not.The granting of a permit does not presume to give authority to violate or cancel ihe provision of any other state or local law regulating consiruction <br /> That I am authorized by ih ner of this property to perform the work for which application is made and I comply with the State Coniractors Law 18.27 RCW and 296.200A WAC. <br /> � !N��� <br /> Owner/Authorize e Signature Date (Revised 4/2015) <br />