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I <br />F <br />• • • <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 />ITEADDRESS:���� ���Ab/b!l'ry �� IPRoo393ydolav3n3 I P�R u�V11Q�' <br />�L i� <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />�WNER HA/vN�J�"/ �i`'" _ �/ � � Phone/E-mail <br />I�[r7_1►�1 <br />ONTRACTOR <br />idress � � � <br />Owner _ Owner's Agent � <br />I�A�I B�'A� Sl6l� <br />/v • <br />�1(�'/lE'� GI�E�/l�G�� <br />BUILDING PERMIT APPLICATION <br />ICity/State/Zip <br />_ Contractor�S Ag@f1Y _ T2f1811t (must provide a letter of consent from the owner to do work in the <br />1�f�N State Lic. # n/ loSCa �rn City Bus. Lic. # y�%?j(,{� <br />t 9�81a Phone/Email 2��% 28Z��1�0 <br />ONTACT FOR PERMIT s�'✓� j����j�G11� <br />Phone/E-mail ZW - v0 Z'07�Q �f'ji✓eZ�✓i� <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Building <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family <br />T e of ro ect: New Addition Remodel Re air T.I. <br />DESCRIPTION OF WORK (additional space provided on the back): <br />o�N� ( 3 Q'1� ��'"���¢ �a� luu�,�I�1eD N� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />I 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 dryer <br />Ranqe hood <br />Exhaustfan <br />� Heat um <br />Unit heater <br />Boiler <br />Woodstove <br />SPRINKLER / SUPPRESSION SYSTEM <br />i Nurp'�er of Heads <br />C mmercial <br />rinkler <br />'I c+✓f . <br />HEAT SOURCE: <br />Electric Other <br />�� <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixfures <br />Toilet <br />Bathtub <br />Lavator wash basin <br />Shower <br />Kitchen sink & dis osal <br />� Dishwasher <br />, Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />j Backflow preventer (inside bldg) <br />Urinal <br />Drinkin Fountain <br />Floor drain <br />j Grease trap <br />� Roof drains <br />� Medical Gas <br />I Other: <br />; Other: <br />�� <br />I hereby certify that I ave r d a 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 comp <br />with whether specif' d her i o not. The grenting of a permit does not presume to gfve authonty to violate or cancel the provision of any other state or local law regulating construction <br />That I am authoriz by t er of this propeRy to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />f o-dG-�� �1 z <br />Owner/Autho ize A nt Signature Date (Revised 4/2015) <br />