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� <br />�ERMIT APPLICATIQ <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 />%'' � � ��c,_I�'/�� `" ' <br />" � <br />EGAL for new construction: Short PlaUsubdi� <br />�' � <br />WNER �� '� �� f� ! . r;�'�7�C, <br />, <br />idress � ��' 2 �'� ' ��� f ,�L <br />PPLICANT: _ Owner _ Owner's Agent <br />ONTRACTUR <br />idress <br />IPROPERTY TAX # <br />i r�'� '� -? q "� <br />PERMIT # <br />No. (attach copy of Ibng legal description) <br />��� Phone/E-mail l 2�; 7 �� ;� � j� <br />���'' Jr:�. City/State/Zip .�., *,�r,,.. -- ��.::�� _ <br />_ Contractor _ Contractor�S A je�t _ T@fl8fll (must provide a letter of consent from the owner to do work in ihe space) <br />State Lic. # <br />Phone/Email <br />City Bus. Lic. # <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �� � C'�C� ; C�� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas �lectric other_ <br />Building type: --e Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition � Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF K(additional spaceprov� edon the back): <br />�/ , <br />r"!-,"/�„t;c� �./ C";ri�:� �' f='c<n l,�r' C'�7'%f'� �, '�l!� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIOI� <br />Type of Project: _New _Addn _Alteration _Repair Type of Project: _New ^Addn _Alteration �Repair <br />Show Number (#) of fixtures Show Number (#) of fixtures <br />i A/C — air handling units Toilet <br />/ Forced air svstems 1� Bathtub <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 />erngerauon <br />� i Ducting <br />l Other <br />SPRINKLER / SUPPRESSION <br />I Number of Heads <br />M <br />/ <br />in) <br />Shower <br />Kitchen sink & d <br />Dishwasher <br />Sink (service/bar/mop/etc. <br />Backflow preventer (inside <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this appiication and know the same to be true and correcl. All provisions of laws and ordinances governing this type of work wiil be complled <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 consiruction <br />That I am authorized by the owner of this property to perform the work for which application is made and I compty with the State Contractors Law 1827 RCW and 296200A WAC. <br />� <br />� � � , � 7 � <br />/� - — /../ ��/% <br />Owner(Authorized Agent Signature Date (Revised 4/2015) <br />, / <br />J��`, �C � � .S 5 � �'/ /�C`j��✓��1 � f -���i-i? <br />- ��2 <br />