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• • <br />���.��� ����Q��`l� Q�� <br />C��B��I ��1���1���9����/����q�1�9�/�s��/��G�O�I�L��/����ap`���� <br />c��rv o�' �v�r���r ����i�r s��v�c�� <br />3200 Cedar St., �verett, WA �8201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />DDRESS: <br />'Z � ��+-i ,� � � � �': <br />for new construction: Short Plat/subdivis <br />OWNER (',;, <br />iress �?C���' �.� (,:•� r � G�=�>y� <br />PLICANT: _ Owner _ Owner's Agent <br />PROPERTYTA){# y�� RIMIT <br />• �' `i (� � Z � ��% L`� C ' � C.`� I r 11 � l) � ' � � <br />Lot No. (attach copy of long legal description) ' <br />Phone/E-mail ZL'C -- �I��— .'��j` <br />City/State/Zip ��, t c� i"� I,t.' r"� <br />Co�ffaotof _ CofltfaCtD!'S Age�f _ Tellallt (must proyida a le(ler of wnsonl from the ownef to dp work In Ihe space) <br />CONTRAGTOR �,�� �� ���=-� ����� ���u���— Stafe Lic, #�.����--�J��G�� � City Sus. Lic. #�i('r <br />4ddress 2 ��v �l�l,� {�l,) V . � V;=�(��Z`� . I.(,� � � � �� ( PhonelEmail � �� •- 2�� � d � �/ <br />".�„ . .... . �.�.. .. .... _ � r'tVL l� � 4_5'y �� �-�-''�1 : � t r"� <br />,r,� �1 <br />� t�C. C� L G t y,,"i t di:'�,�1?' L� ,.} l Gr J,s'�%1/1�1� Phone/E-mail 17� Z, �. Z� Z��/� <br />BU1�. ING PERMIT APPL.ICATION coNTRacr PR►cE oF woRtc � <br />Existing Use of Bullding (" L ������` <br />Froposed Use of Building ��� C`����� ` <br />Building type; � Singie Family _ Quplex _Townhouse _ Multi-Family ,�. Commercial <br />Type of project: New ._ Addition _ Remodel � Repair _ T.I. _ Sign _Sprinkler <br />6 k' <br />HEAT SOURCE: <br />Electric,; Othe <br />olition_Change of Use <br />DESCRIPTION OF WORK (addi6onal space prov�c�ed on.fhe ac ). �, <br />._ � �, �, , � ; � � �� � c` �) i`>�� t i � � y. y �l�i� ��l z � � � �_ <br />�� �.f°Z- ��-- I�.. i C,cl�Ir�' w'� �,�-� [�, �.7 i���,� ���-�; �..:, i✓�� � 3 <br />MECHANiCAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Projecf: _New_Addn _Alteration � Repair Type of Project: _New_Addn ,_,Alferatio� _Repair <br />ShowNumber(#) offixtures ShowNumber(#J offixtures <br />A/C — air handling units Toilet <br />Forced air systems Bathtub <br />Gas piping i.avafory (wash basin). <br />1/1/atar haaiar I Sliower <br />� �as nrepiace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Neat pump <br />� Unit heater <br />� Boiler <br />I Refriqeration <br />� Other <br />SI'1�1�1�5l��� / ���� r�I���d��l ��i�`�'�9}f! <br />Number of I-leads <br />Kitchen sink & disposal <br />Dishwasher ' <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc,; <br />Backflov✓ preventer (inside <br />Drinking Fountain <br />Flaor drain <br />Grease frap <br />Raof drains � <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined ihis appifcation and know lhe same to be irue and correct. All provisions of laws and ordinances governing fhis lype of work will be complied <br />with whether specified herein or not, The granting of a permit does not presume to give authority {o violate or cance� ihe provision of any other staie or local laW regulating wnsiruction <br />That I a aulhorized by ihe ownef of this property to perform the work for which application is made and I comply with ihe Siate Contracto�s Law 18.27 RCW and 296.20oA WAC. <br />���� C��',�� - 3v -r � <br />A�NF%r/Authorize AgentSignature Date (Revised4/2075) <br />. I � <br />