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-i 1,. <br />������ ��� .�� <br />�� �c.� <br />• <br />PERMIT APPLICATION <br />BU�LDING/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 />� ��'� ( � -L�� <br />SITE ADDRESS: (� l PROPERTY T X# k � PERMIT # <br />� l�� �� � �OQ- �'� �" j L�/ l� 3 � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER G� �In� tl��tC��1 G�'h� �`�i � L,�,� � �� .- T�� Phone/E-mail �� � - ��'S � , (../ <br />—. <br />Address � �' j �,� r City/State/Zip �( � ;, � �� �� <br />APPLICANT: �[ Owner _ Owner's Agent _ Contractor _ Contractor's Agent _ Tenant (musc prov�de a ieccer or consern from cne owner ro do work in �ne space) <br />CONTRACTOR `%Cl�.�`l�t�-'� <br />ress <br />BUILDING PERMIT APPLICATION <br />r, <br />Existing Use of Building �V r;i � O CLr-� � <br />Proposed Use of Building�� I �� ���� <br />Building type: _ Single Family _ Duplex _Townhouse � <br />Type of project: New Addition Remodel �Repaii <br />DESCRIPTION OF WORK (additional space provided on the back) <br />j.}-�cP� � � -t � � ��'�cv��� � U� � c..S� . <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />j A/C — air handling units <br />I Forced air svstems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes drver <br />Exhaust fan <br />Heat pump <br />Unit heater <br />; Refrigeration <br />Woodstove <br />Ducting <br />j Other <br />SPRONKL.F_IR / SUPPRESSION SYSTEM <br />� Number of Heads <br />State Lic. # <br />City Bus. Lic. # <br />Phone/Email <br />CO TAC FOR P RM17 <br />i� �����e ���,� E I��c:v�' .�,c�s��,r���.� <br />Phone/E-mail � �S ,� � �j �->���j(,� V'Y\ � Cl ` L �JY�(1 <br />CONTRACT PRICE OF WORK �` r LL.,i�?� � <br />HEAT SOURCE: <br />i <br />L_�y� Gas_ Electric i.� Other_ <br />Multi-FAmily _ Comm rcial �� <br />T.I. _ Sign _Sprinkler _Demolition � Change of Use <br />� �7��! �.a;� � t 7l� � li� 61r -� ! i.��,� �� � t1"�1 <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixiures <br />; Toilet <br />! Bathtub <br />j Lavatory (wash basin) <br />j Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />; Sink (service/bar/mop/etc.) <br />i Backflow preventer <br />Urinal <br />Drinking Fountain <br />i Floor drain <br />Grease trap <br />Roof drains <br />� Medical Gas <br />Other: <br />Other: <br />I hereby ceRify 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 prcvision of any other st3te or local law regulating construction <br />That I am authorized by the owner of 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 />� ��/� <br />il�, <br />� ^ � _' � - L i..�-' ���� � - <br />�� <br />Owner/Aufhorized Agent Signature Date �(�� //\ (Revised 3/2013) <br />l� ,,� <br />