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�PERIllili APPLICATI��V <br />BUILDIN(�/MECHAtVICAL/PLUMBING/SIGN/SPRINKLER/DEMOL,ITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS:,.- <br />.; � z � U'G, I��J � ��� <br />TAX # <br />��� � 1 � 0 3vc� <br />ir <br />LEGAL for new construction, Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br />) / u zi�- Zy� <br />OWNER L ✓' � � �-- 13� �A✓�� :..� Phone/E-mail %_ �) „*�AV'c� :.✓1 � : � � r �, C i;' �! � �'� � <br />Address S�� Z� (�� �2 c i �i �� Z City/State/Zip � v� �'�. f�- C.�.l /} C'� f� ZLy f <br />APPLICANT: � Owner _ Owner's Agent _ Contractor ir Contractor�5 AjBfll _ T8f12f1Y (must provide a letler of consent irom the owner to dp work in ihe space) <br />TOR <br />S'a�, -�-� e <br />r-� f/� __5 s� �l� •�.., .� State Lic. # I Z P-�%�+l ��U1 ��f r'% City Bus, Lic. # C� �� L�E i <br />PhoneiEmail �i ? S` "" Z�r 9 ` / ,'I �.� <br />BUILDING PERMIT APPLICATION <br />r= � , _ >s .. _�;� ,�: <br />� 7 �- � � � % - l�` �= .1 <br />�one/E-mail <br />ONTRACT PRICE OF WORK ( G� `� �^ <br />Existing Use of Building Si �y �< l�� �•^ ��� �Z�i��'�� -c� HEAT SOURCE: <br />Proposed Use of Building S�`%� Gas_ Electric� <br />Building type; � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition � Remodel Repair _ T.I. _ Sign _Sprinkler _Demolition_ChangE <br />DESCRIPTION OF WORK (additional space provided on the back): �- <br />� �'c K.c . <br />/— � � �. IC .:Z �✓''� ��, �..r�c�d�t W �c'sC � ,� <br />(� �) f/ �i�'.-. c!. + ca � 1 � ar , � ..� � c: � � � c_ � <br />MECHANICAL PERMIT APPLICATIQ <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 />Heat pump <br />Unit heater <br />� Boiler <br />I Refrigeration <br />� Woodstove '��� <br />! Ducting �� <br />� Other <br />SPRINKLEIR / SUPPRESSION SYSTE <br />Number of Heads <br />Othe <br />of Use <br />t� 4:,z;��/ <br />LICA <br />of Project: _New _Addn ,_,Alteration _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />�avatory �wasn pasin� <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease tra{i <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 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 property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />/'L`—�_ G � ;-- i 5' <br />� �; <br />Owner/Authorized Agent Signature Date (Revised 4/2015) <br />V�� <br />