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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 />ITE ADDRESS: <br />2►O I l <br />�\%L <br />GAL for new construction: Short PlaUsubdivisioi <br />VNER ��,Y1 �'� I� I �� ��7L_\ <br />iress Z. � U � ���+�� <br />PLICANT: �Owner _ Owner's Agent _ <br />1NTRACTOR �7 C 1 � <br />C'L� <br />Contractor <br />BUILDING PERMIT APPLICATION <br />PeRTv rax # <br />., <br />Lot No. (attach copy of long legal description) <br />PhonelE-mail � � � 2_�C� - � � � � '�- �, �j � � � '�-' ����y, <br />i r�� <br />U� City/State/Zip ��; L'.Q`� - � �� (,) � C�- �� � <br />Contractor�S A9@flt _ T2flaflt (must provide a letter of consent from the owner to do work in the space) ' <br />State Lic. # <br />I Phone/Email <br />ACT FOR PERMIT <br />City Bus. Lic. # <br />PRICE OF WORK ,�'��L����� :: �� <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel X� Repair _ T.I. _ Sign _Sprinkle <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />I�� L �,_C �_k � c��l ;�,C7 <br />� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fiztures <br />A/C — air handling units <br />� Forced air systems <br />Gas i in <br />Water heater <br />Gas fire lace <br />Gas ran e <br />Clothes d er <br />Range hood <br />Exhaust fan <br />� Heat um <br />Unit heater <br />( Boiler <br />Refrigeration <br />� Woodstove <br />� Ducting <br />—� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />HEAT SOURCE: <br />molition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <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 lhat I have read and examined this application and know lhe same to be true and correct. All provisions of laws and ordinances governing this type of work will be compl <br />with whether specifed herein or not. The granting of a permit does not presume to give authority to violate or cancel �he provision of any other state or local law regulating construction <br />That I a authonzed by the qwner of thi pro erty to perform the work for which application is made and I comply wilh the State Contractors Law 1827 RCW and 296.200A WAC. <br />�� :-'���.�� �� ����,��Ln _� , � I � 2 G� S— <br />Owner/Authorized Agent Signature Date (Revised 9/2014) <br />