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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 vwvw.everettwa.org <br />ADDRESS: <br />for new construction: Short PlaUsubd <br />ER <br />Iress�1� �G,1• b <br />PLICANT: Owner <br />ONTRACTOR �j��{�j � <br />�dress�� �� 6�� <br />ENANT BUSINESS NAME <br />Owner's Agent <br />PERTY TAX # P RMI, # <br />IO�i'�'Gdd"o17� •DD �iR�� i� � <br />_Lot No. (attach copy of long legal description) <br />Phone/E-mail <br />00 ad ICity/State/Zip � V��l , NV ¢�11 �F� ,., <br />COf1tf2CtOf _ CO(1tf8CtOf S f1g@flt _ TEflBflt (must provide a letter of consent from the owner to do work in the space) <br />State Lic. # <br />Phone/Email <br />#�of�'1t�VW�'f 1BN <br />79-� City Bus. Lic. # <br />�•1� �;�,•,��q�+,l• <br />t��-(�� .�,�dk <br />1�i6 ',-ht�,kera�rt'.l�t � r.t�eds e�. <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 2 BoO. bD <br />Existing Use of Building (/A% �j1�'/J�/ HEAT SOURCE: <br />i <br />Proposed Use of Building (/I� 81�9�'� Gas_ Electric Other <br />Building type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New _ Addition �� Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition Chanqe of Use <br />DESCRIPTION OF WORK (additiona/ space provided on the back) : <br />�r►r�� ��. a� �w�r� �n�,� i��r►�� �au� p� t1.c� u�rl�t n�tv �- <br />1�iL1T�'h��IT�% �l���dl. �Nh 9T�'tJ�(IA��1/ /cl� fk'r N� Co���'—�4�F 'i� � <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New_Addn �Alteration _Repair <br />Show Num6er (#) of fixtures <br />Q � A/C — air handling units <br />� i Forced air systems <br />p ( Gas piping <br />I Water heater <br />p Gas fireplace <br />Q Gas range <br />j Clothes dryer <br />Ran e hood <br />Exhaustfan <br />Heat um <br />Unit heater <br />0 Boiler <br />Q Refri eration <br />� Woodstove <br />' Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />1'� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn �Alteration _Repair <br />Show Number (#) of fixtures <br />9j Toilet <br />1 Bathtub <br />G <br />Lavatory (wash b� <br />Shower <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/ <br />Backflow preventf <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />e <br />I hereby certiTy that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming lhis type of work will be compi <br />with whe ecifed herein or not. The granting of a permit does nol presume to give authonty to violate or cancel the provision of any other state or local law regulating construction <br />That I �uthon d by the owner of this property to perform the work for which appiication is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />ionzed gent Signature Date (Revised 4/2015) <br />� �� rl <br />-r �vn�c���l �tr�cN�i Z <br />