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��ERtVII°T APPL.ICATIC:. . <br /> BUILDINC�/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOL,ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-$810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS' U� ' PROPERTY TAX#i PERMIT# /,� <br /> J V <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER S -�, s ;� Y. �� .._ Phone/E-mail <br /> Address '� �. � � City/State/Zip <br /> APPUCANT; Owner _Owner's Agent _Contractor _C ntractor�5 A92flt _Te�Bflf(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR �S, � ,� State Lia # City Bus. Lic.# <br /> -I'��� �� �� �;��iJ/ �G �U�����- <br /> Address '• Phone/Email � '�� <br /> CONTACT FOR PERMIT <br /> c�lL��'l1 l��c%�1�';1/%�,. / / <br /> Phone/E-mail V ��4' ���?'!' `"J` �=E_ <br /> BUILDING 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 /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _,Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping � Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer � Clothes washer <br /> Range hood Water heater <br /> Exhaust fan � Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> � Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting � Roof drains <br /> � Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads 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 granti qS a permit does noi presume to give authority to violate or cancel the provision of any other state or local law regulating construciion <br /> That I am authorized by t r of this pro rt to,/perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> � <br /> Ow r/ iz ge Si re Date `��� /j��j,,� '�j�G�' (Revised 4/2015) <br /> t <br /> C S��Z l/�I.�Il�"L '�'�'Ci��;L" <br /> �����f jl1 C��IG�JY ��G�i�l�'Z1/ <br /> '��,�'i.E Ci27 L�- L��E�.l L�>� `f/l�t� <br />