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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 />ADDRESS: �� i%,1'`1 U 7 r� ��rC, � IPROPERTYTAXit I PE�IT# �_�i <br />�` � <br />�L for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />ER �q�i"�,a �P �0 �1� W1u ln� �v �NIA(i �'1 �U(rp rf PhonelE-maii <br />Address ��(� � 7�� �� ��� � <br />APPLICANT: _ Owner _ Owner's Agent V Contractor <br />CONTRACTOR <br />Address � !ej <br />L <br />ICity/State/Zip ��/P�P �� <br />COf1f�8CtOf�S A9811t _ T2f18f11 (must provide a letter of consenl from lhe owner to do work in the space) <br />Lic. #/ �L 1 City Bus. Lic. # <br />Phone/Email �� � �� ��j / � <br />(' � <br />Phone/E-mail `7 � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Building � .�1, �C.� <br />Proposed Use of Building � I��t �r � �� <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition � Remodel Repair _ T.I. _ Sign _Sprinkler _[ <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />MECHANICAL PERMIT APPLICATION <br />pe 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 />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />; Refrigeration <br />; Woodstove <br />Ducting <br />j Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />� ,� <br />HEAT SOURCE: <br />FIPr.trir. V <br />Change of Use <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />Lavatory (wash basin) <br />� Shower <br />� I Kitchen sink & disposal <br />j Dishwasher <br />� j Clothes washer <br />' Water heater <br />; Sink (service/bar/mop/etc.) <br />� Backflow preventer <br />� Urinal <br />I Drinkinq Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: ���y��; <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 properly to perform the work fo� which application is made and I comply with the Staie Contractors Law 18.27 RCW and 296.200A WAC. <br />�� i/��/ � <br />9 3��- � <br />ner/Authorized Agent Signature Date (Revised 3/2013) <br />