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� ERMIT APPLICATIC�� <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 /> SITEADDRESS:, PROPERTYTAX# PERMIT� ,, , <br /> �° r�:��� ���� 5�� 5�. ���/%������ f ��-,� (1� �� ^ U � <br /> , � <br /> LEGAL for new construction: Short PlaUsubdivision � �'1�kk� �i'lL ��� � Lot No. �1 (attach copy of long legal description) <br /> OWNER �` c' L( �. Phone/E-mail � �������t�� <br /> ' 1 �� �fa/r_.� � ,� / `C_,_ %�S-1�/-e-�-lf���r;��y�� �'t�� ,..o,�-- <br /> Address � �t �� /C�I�°.S� .Sl-�. � 1c.�, City/State/Zip�r,`�.0 ��r�b!%� 5 t ��'.:J')�.. <br /> APPLICANT:_Owner �Owner's Agent _Contractor _Contractor�S AgBflt _T21lal1t(must provitle a letter of consent from the owner lo do work in ihe space) <br /> CONTRACTUR '� ' "" r �� �� State Lic. #��'����,�,����''�I��^� Gity Bus. Lic. # � <br /> ' l/�2E�%f ���.1,�/.�'�� ��.:�: <t t���--� <br /> Address �v�6y=Y'"r-!- Phone/Email��jsf�'� <br /> CONT CT FQR PERM,/IT Q ,��. 3 y � <br /> /�• ��4� �F-•��� C�'��.�.^.. ��' �.I' ��/ � �C �d <br /> Phone/E-mail ��� i✓� ��fr'r I�Z'���t�c �'' [ ��i�K�t�%/�c'� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK .; �.> <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building ''t"� GasJQ 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 /> � f,, / ;..,���:�." �- •,. ��'f' i . ?/� ��._. <br /> ��..�'i, ° <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 i Toilet <br /> / Farced air systems � Bathtub <br /> Gas piping ""' ; Lavatory(wash basin) <br /> i Water heater / ! Shower <br /> " I Gas fireplace / i Kitchen sink&disposal <br /> f' ! Gas range i Dishwasher <br /> _ Clothes dryer Clothes washer <br /> Range hood ater heater <br /> v�"" Exhaust fan / ; Sink (service/bar/mop/etc.) <br /> Heat pump i Backflow preventer(inside bldg) <br /> -- i Unit heater Urinal <br /> --Y ( Boiler ; Drinking Fountain <br /> -- ! Refrigeration Floor drain <br /> �- ; Woodstove — ! Grease trap <br /> -- I Ducting �- j Roof drains <br /> � Other __ i Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM ; Other: <br /> j 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 wheth r specified herein or not.The granting of a permit does not presume to give authority io violate or cancel the provision of any other state or local law regulating construction <br /> That I am uthoriz�,Q by the owner of this propeRy to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> �,�,• ��/�I(". ����� „`, - <br /> E. <br /> r/Authorized Agent Signature Date (Revised 4/2015) -� <br /> �1��� <br /> d <br />