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� • <br />PERMIT APPLICATION <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 />TE ADDRESS: � �y �/j� ,,+� <br />iL�> >�r r�c r'L�77 F` �l G' �� W!x <br />LEGAL for new construction: Short PlaUsubdivision � <br />OWNER ~ = Lw f/-� � <br />Address '�3(� ,�%%�td ,-F•/yt�2� �E'!✓� <br />APPLICANT: _ Owner _ Owner's Agent _ Contractor <br />R <br />Address <br />PROPERTY TAX q <br />� <br />Lot No. (attach copy of long legal description) <br />Phone/E-mail ��j,, }C/Z ' j��!%G`�i <br />City/State/Zip �//[. �7r,; �e Ci� %S�3-�- <br />Contractor's Agent � I18ftl (must provide a letler of consent from Ihe owner to do work in lhe space) <br />State Lic. # <br />Phone/Email <br />Bus. Lic. # <br />ILI�A1�1 UVVII��VV1�I11YIL VVIYIMVI rVI�rGR1Y111 <br />� ; / �� ��� ti �D�dr`_ <br />l f`' • �" Phone�E-mail ' JZ3S- Zlv% 3 <br />BUILDI PERMIT APPLICATION CONTRACT PRICE OF WORK ��'� °�' � <br />Existing Use of Building /LfS�"Gj (F frvtt'" HEAT SOURCE: <br />Proposed Use of Building ��'�� Gas � Electric r other <br />Building type: _ Single Family _ Duple�Townhouse _ Multi-Family ?/�Commercial <br />Type of project: New Addition Remodel Repair T.I. Siqn Sprinkler Demolition Chanqe of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />C���L.'iG�/r ��YNii'�.Y/( <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn � Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />I Forced air systems <br />Gas piping <br />Water heater <br />i Gas fireplace <br />I Gas range <br />; Clothes dryer <br />� Range hood <br />� Exhaust fan <br />Heat pump <br />� Unit heater <br />, Boiler <br />i Refrigeration <br />� Woodstove <br />I Ductinci <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />I Lavatory (wash basin) <br />! Shower <br />Kitchen sink & disposal <br />Dishwasher <br />� Clothes washer <br />i Water heater <br />i Sink (service/bar/mop/etc.) <br />; Backflow preventer <br />I 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 construction <br />That I am authorized 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 />� � � <br />9�.� �y <br />er/Authorized Agent ignature Date (Revised 3/2013) <br />