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���.�9�' �I��,Q���l <br /> �UI��IN�/(V������IC�A�./PL���Ii�G/SI��/�PR1�9����I�����IT�O� <br /> � CITY OF EVERETT P�RIVIII' SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTYTAX# PERMIT# <br /> � ��/ <br /> !� y ��� � ,�j � <br /> L��� �c���L� - n �c�r- L'e. �=G`zi C � • . .� �C�� . <br /> L�GAL for new construction: Short PlaVsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER ,��:s/�«� (,�s�t,-z�a�Gt o Phone/E-mail yZ5- '�N7i - cSc�/ rc�s��l� l�r�ua./��^� <br /> Address =�//-/ �c�c�-=c��%//E,. , �� ' - ity/State/Zip �=r-z��-{.� G� /� "'G <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(m�5t provida a leuer or�onseni from me owner to aP woric in me spa�e) <br /> CONTRACTOR c'�.%<�rr State Lic.# City Sus. L.ic.# <br /> Address -;�,:N � PhonelEmail <br /> CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUII.DING PERMIT APPLICATION cONTRACT PRICE OF WORK <br /> Existing Use of Building � HEAT SOURCE: <br /> Proposed Use of Building 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_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ���/��� � �,��,�j ;�iu:n �:.-J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn ,_,Alteration_Repair <br /> 5how Number(#)of fixtures 5how Number(#)of�xtures <br /> A/C-air handling units 2 Toilet <br /> Forced air systems f Bathtub <br /> Gas piping _> Lavafory(wash basin). <br /> Water heater i Shower <br /> Gas fireplace i Kitchen sink&disposal <br /> Gas range $ Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan i ' Sink (seNice/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal - <br /> � Boiler Drinking Fountain <br /> Refrigeration Flaor drain <br /> Woodstove Grease trap <br /> I Ducting J Roof drains � <br /> � Other Medical Gas <br /> SPRING�CLER / SUPPQZESSIOfd SYSTEM Other. <br /> Number of Heads Other: <br /> I hereby cerfify that I have read and examined this applicaiion and know the same to be irue and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein o�not.The granting of a permit does not presume lo give authority to violate or cancel the provision of any other staie or local law regulating conslruclion <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 98.27 RCW and 296.20DA WAC. <br /> 9 � <br /> �'�� ��/_ G'i. /E". �C/S <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />