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: 'ERMIT APPLICATIC. � � <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRIIVKLER/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 /> SITE ADDRESS: PROPERTY TAX# PE MIT# <br /> �y 3 �� ��,� -�. � �-`� � - 2C��� S �G - C7 <br /> LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER � � —r'r ti� `)L�Phone/E-mail <br /> a,ddress `��--����1 ' v c.k ��t.,.� r•� c�tyistateizP G' �.(c—'_ �T E; � C�Z <br /> APPLICANT:�Owner Owner's Agent _Contractor _Contractor's Agent _Tenant�must provida a ietter or�onseni rrom ine owner io ao work in me spa�e� <br /> CONTRACTOR �j— ; ;= State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> =,�� O -� �J_ 1� � a-I -�. � L.{�,��ti='�._ � .- /.�i - � � � v a _�l`�,,,_ � <br /> �: � � ; �Y��t;��_ 1�� `��. c r, . � � <br /> Phone/E-mail ��Z j - c � � �„ � �p u <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK��� �a <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 /> .� � <br /> � � <br /> � �� ...�� :.�.�� �� �w "S�', x�l z— 5 L O � �S N �<< i�— i t-�,�-�.f%'....Sl <br /> �� ' <br /> q-z"° ��::��b� L ��-�.d�i ��'--��� � �1 �a-� v�-�,a��� a-� ��1-4c�-�� Zc w l � <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 I 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 ave ead and ex ined thi 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 sp cifie her ' or not. he granting af a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating consiruction <br /> That I am autho iz y the wner of his property �perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> / � � �i l, � c=U � �� <br /> Owner/Authorized Agen Signa re Date (Revised 4/20i5) <br /> ��z �� <br />