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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 />AD <br />LEGAL for new construction: Short Plat/subd <br />�p ,1 <br />OWNEf� ��} \� 1 �v� �� �\ r��'N � <br />PPLICANT: /Owner <br />ONTRACTOR <br />dress <br />:NAN <br />TAX ti PERMIT # r; <br />; �I,( �� �-(,� �; � f% �-� <br />No. (attach copy of long legal description) <br />� . d , <br />Phone/E-mail �.i 1 � <br />�, ' <br />�� 1 City/State/Zip � �/I 1� C �''� (' ¢•-t.;c ct � , it., � <br />Owner's Agent _ Contractor _ Contractor�5 AgEflt _ T8�8f1t (musl provide a letler of wnsent from ihe owner to do work in ihe space) <br />State Lic. # <br />IPhone/Email <br />ACT FOR PERMIT <br />Bus. Lic. # <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��!�'�� <br />Existing Use of Building %' i HEAT-SOURCE: <br />Proposed Use of Building _ w Gas Electric_ Other <br />Building type: ./rSingle Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel -'" Repair i T. L_ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the bacic) : <br />n <br />��:� ��v��2 '�� Ci�,;,, y�� �� G'��'� �Ci��� .� ���'�n�j,,'�,, CL U- c�" c c�, � u�- �'.� �� <br />� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />I A/C — air handling units <br />� 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 Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration G-Repair <br />Show Number (#) of fixtures <br />,� p�� i Toilet <br />'��� `�;,�T ; Bathtub <br />� Lavatory (wash basin) <br />n; ,,�� � ShoWer <br />�` j Kitchen sink & disposal <br />Dishwasher <br />; Clothes washer <br />i Water heater <br />I Sink (service/bar/mop/etc.) <br />i Backflow preventer <br />I Urinal <br />'; Drinking Fountain <br />� Floor drain <br />Grease trap <br />Roof drains <br />i Medical Gas� � <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 wheth 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 uthorized by the owner oi this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />,= �l� <br />. <br />/_ �. <br />i--__-.__�._.�_ _ <br />O er(Authorized Agent Signature Date (Revised 3/2013) <br />