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�13�� ��� <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 />ADDRESS: <br />/�Z� 11Z�'`—' Sr S� S��Ec <br />�L for new construction: Short PlaUsubdivision <br />'NER <br />ress <br />ICANT: _ Owner _ Owner's Agent <br />ress <br />TAX a <br />PERMIT # <br />� <br />No. (attach copy of long legal description) <br />Phone/E-mail <br />ICity/State/Zip <br />COfltfaCtOf _ COf1if2CfOf�S A9ellt _ TBtlafli (must provide a letter of consent from the owner to do work in the space) <br />BUILDING PERMIT APPLICATION <br />State Lic. # <br />Bus. Lic. # <br />PhonelEmail �(�,�� - �y (p J —5 S � � _ <br />R PERMIT <br />one/E-mail <br />J1 A.��YV:IIL�L��yP�li1.Y4LJ��v�.CJ'r� <br />)NTRACT PRICE OF WORK � ��� �' <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building <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 />�'�l �� ��'-i�f� �Q-� f'r����. � ���.- �-��.-� s��-�-c__ <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />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 />j Heat pump <br />� Unit heater <br />; Refrigeration <br />i Woodstove <br />Ducting <br />( Other <br />SPRINKLER / SUPPRESS <br />Number of Heads <br />SYSTEM <br />Chanae of Use <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />% i Lavatorv (wash basin) <br />Shower <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/ <br />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 ihis 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 ihe owner of this property to pertorm lhe work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� /�' � � Z - Z� %� <br />Owne uthorized Agent Signature Date (Revised 3/2013) <br />