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� � <br /> ��RM'� ��r�l���l��� <br /> �1J1�,�ING/MECH�4NIC�►L/PLUMBING/SIGN/SPRINKLER/DEIVIOI�iI"ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 wv�niv.everetiwa.org <br /> � /1 'D(� <br /> SITE ADDRESS: PROPERTY T X ti PE MIT# <br /> ��� �r�� 8�t'°� �Q �'��..��3 �� �� �v D� -0� <br /> LEGAL for new construction: Short PlaVsubdivision �'l��� ��� � Lot No��(attach copy of long legal description) <br /> OWNER �'T,T'�- �D'�'8►" �� `y'��+ '-" �� � <br /> Phone/E-mail �� <br /> Address �j��9 �- �^�D � , � City/State/Zip ���56'&1�� �fd� �"2.� <br /> APPLICANT:�Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(musc pro�ide a iener or consen�rrom me ow�,er�o do work m me spa�e> <br /> CONTRACTOR � !AI(�1 Q►�1�EifL State Lic.# City Bus. Lic.# <br /> Address ���� — � V�-� �� ���SIf I �� Y�'{� 1��'1'" Phone/Email ��� ���6 — �J� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �� �� <br /> �i�F/L�("11Z��.N � ��� Ap� t� <br /> - Phone/E-mail C 2 v�� `T� °�'�' ���-� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK�� 9 DO_ � <br /> Existing Use of Building � o � HEAT SOURCE: <br /> Proposed Use of Building W-�� f��v �f Gas I.� Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family ✓Commercial <br /> T ey� of pro ej ct; �New _Addition __ Remodel Repair �T.I �Sic�n�__Sprinkler _ _ Demolition Chan e of Use <br /> — � <br /> DESCRIPTIOfd OF WORK(additional space provided on the back): <br /> �--��'� � 1 �N°� � �� r �i� I �� � � ���� ` d�''rb�. �=-�' <br /> 0�+�.���-�ri�. �T� � �� �"v a �a'.� � � (�- co�� . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteretion_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fxiures <br /> A/C–air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in `� Lavato wash basin <br /> Water heater � Shower <br /> Gas fire lace � Kitchen sink&dis osal <br /> Gas ran e � Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan °� Sink service/bar/mo /etc. <br /> � Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler � Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin 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 compl <br /> wilh whether specified herein or not.The granting of a permit does not presume to give authonty lo viola�e or cancel lhe provision of any other state or local law regulating consWction <br /> That I am authorized by the owner of this property to per(orm the work for which applicafion is made and I comply with lhe State Contraclors Law 18.27 RCW and 296200A WAC. <br /> o�, �� �E` <br /> , <br /> , <br /> O erl ut rized Agent Signature Date (Revised 9/2014) � <br /> I C1 <br />