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PERMII' APPLICATIfJN <br />BUILDIiVG/MEGHANICAL/PLUMBINGISIGN/SPRINKLER/DENIOLIT'IDN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX �25-257-8857 www.everetiwa.org <br />SITE ADDRESS: <br />c31 . S� <br />u <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (atiach copy o( long legal descripfion) <br />OWNER <br />PhonelE-mail <br />� <br />Address �� ��r� � • s�, ICity/State/Zip �� ��f �NI� ��Z�r <br />��� <br />APPUCANT: _ Owner _ Owner's Agent k Contractor _ Contractor'S Agefll _ TeIlBf11 (musi prooide a letter ot consen� lrom tho ovmor fo do wark in ins space) <br />CONTRACTOR <br />N� �n�T'� C'�-f • <br />7AME <br />BUILDING PERMIT APPLICATION <br />. IState Lic. <br />:y� �PhonelEmail����ij4� <br />ACT FOR PERM17 �,��� <br />PhonelE-mail `�fZ,_�j= .F[f (� - '�,` <br />CONTRACT PRICE OF WORK <br />Existing Use of �uilding � <br />Proposed Use of Building <br />Buiiding 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 prorided on tho back) : <br />l�tle�'' S��-�4�(I�i�'ic�►1 <br />Citv Bus. Lic. <br />:i�'OL�i� �rL�l�iiitll� <br />I � � <br />�. r�, / <br />HEAT SOURCE: <br />GasX- Electric � <br />of Use <br />MECHANICAL PERMIT APPLICATION � � PLUMBING PERMIT APPLICATION <br />of Projact: _New _Addn `�,Alteratic <br />Show Number (#) of fixtures <br />A/C - air handling i <br />I Forced air systems <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeration <br />n _Repair Type of ProJect: �New _Addn _Alteration _Ropafr <br />Show Number (#) of flxtures <br />inits � Toilet <br />� Bathtub <br />j Lavatory (wash basin) <br />j Shower <br />i Kitchen sink & disposal <br />� Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />/1 Number of Heads <br />isnwasner <br />Iothes washer <br />!ater heater <br />ink (service/b� <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certdy tha � I have read and exami�ed this application and know the same to be true and currecl. All provisions o( laws and ordinances governing this type of work wdl be complied <br />i <br />wilh �•methe�r. spe ifed herein or noL The granling of a permil tioes not presurne to yive zuthority lo viulate or cancel ihe provision of any olher slate or lucal law reyulatiny construct:un <br />Thaj1-arrracJt io zed by lhe mer of thi�s property {o pEriorm Ihe �wxk for which application is made and I comply with lhe Stale Contractors Law 18.27 RCW and 296 200A WAC. <br />i l � ;, � ����'" rl <br />..-�- � �'�� 5 <br />Owja rlAuthorizod Ag nY ig�aturo Dato (Revised 3/2013) <br />� <br />