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� <br />� <br />� <br />PERMIT APPLICATION <br />BUILDIN(z/MECHANICAL/PLUMBING/SIGN/SPRI�IKLER/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 />ISITE ADDRESS: PROPERTY TAX il PERMIT # <br />Z�i L(�' 3� l �l ST ��G G �Gi �'fi- ��/i �� c c( f�✓� �� � l�'i ��"�' i <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER I� y<S«�Y �Li; �` Phone/E-mail��iZ> L�2- � � S�`{ <br />Address � �'i � j �,� f , � � �� � � <br />>j •.'l..d-r��, v'�- City/State/Zip I/i�'�2`�f" �°,�i j <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor _ Contractor�s Ag2�f _ T0f12�1 (must provide a letler of consent from lhe owner to do work in ihe space) <br />CONTRACTOR t GK�u� i L� State Lic. # City Bus. Lic. # <br />ress <br />�Phone/Email <br />ACT FOR PERMIT <br />[�.� ("1 L' � � Yr� at,�v` L L L Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric <br />Buiiding type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition ChangE <br />DESCRIPTION OF WORK (additional space provided on the back): <br />� ` .` „ �� ),<, ,� 1- ��; `�� <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />� A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />Water heater <br />Gas fireplace <br />I Gas ranae <br />; Range hood <br />� Exhaust fan <br />� Heat pump <br />� Unit heater <br />� Boiler <br />� Refrigeration <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Other <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />� Lavatory (wash basin) <br />� Shower <br />� Kitchen sink & disposal <br />Dishwasher <br />� Clothes washer <br />� Water heater <br />� Sink (service/bar/mop/etc.) <br />I Backflow preventer <br />Drinking Fou <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 lhis 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 lo give authority to violate or cancel the provision of any olher slale or local law regulating construction <br />That I am aulhorized by the owner of this property fo pertorm ihe work for which application is made and I comply with the Slate Contractors Law 18 27 RCW and 296200A WAC. <br />�' O `�- ��/ <br />� �n�.�'�� ������z-- �� p 2 - <br />