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f • • <br /> ����0� G����Q�li��lY�� <br /> ��9�,����/�I��G����99���/���V`1��1�9�/�d�G�/��'G�O�G�L���/��V���,p�'���9 <br /> ' CIT'Y OF E!/ERETT' P�Rilill`� �E�VIC�� <br /> 3200 Cedar St., �verett, WA �8201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERNTA7{#t PERMIT#_ <br /> D � Do� � � <br /> L�GAL,for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) ' <br /> OWNER �-p(��Qf(�( /'DP L G P1�one/E-mail �Z j_ 2 — Z, . <br /> Addfess �. �O� 5� u City/State/Zip C(/� � �Q( <br /> AFPLICANT: Owner _Owner's Agent ^Coniractor _Contractor's Age�t _Teftant(must provido a letler of conseN trom the owner to dp work In the space) <br /> CONTRACTOR �����y���=-� `�Z�iL ���uG�l� Stafe Lic,# ���t���?G�E%'l City Sus. Lic.# Q'i('r"?`L'�`� � <br /> Address ���v �L�1,� � �/c:-ln��. �;l,t� �U Pn—i'J( Phone/Email ��'�•- 'Z�� ����/ <br /> +�1.�V. � <br /> CON7'QCT FOR PERMIT <br /> � ld.�N� ������. ���w� .� <br /> n ( Phone/E-mail <br /> BUI�DING PERMIT APPLICATION coNTr�.acT PRice oF woRrc ���Z <br /> Existing Use of Building 0 ['��`(�C HEA'T SOURCE; <br /> Proposed Use of Building �D C�f�d Gas_ Electric� Other <br /> Building type: ^Single Family _Duplex_Townhouse _Multi-Family x Commercial <br /> Type of project: New _Addition _Remodel �Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> AESCRIPTION OF WORK(additional space prow ed on fhe back): <br /> ���u� y cuw� �o,u ��c - ,�l� f����.�ai.� t �vs �r�� �./�.�-rr' . <br /> MECHANICAL PERMIT APPLICATIOtd PLUMBING PERMIT APPLICATION <br /> Type of Projecf: _New_Addn _Aiteration°�Repair Type of Project: _,New_Addn ,_,Alteration_Repair <br /> Show Number(#)offixtures Show Num6er(#)of fixfures <br /> ( A/C—air handling units Toilet <br /> Forced ait'systems Bathtub <br /> Gas piping Lavafory(wash basin). <br /> Water heater 5hower � <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher � <br /> Clothes dryeP Clothes washer � <br /> Range hood Water heater <br /> - Exhaust fan ' Sink(service/badmop/etc.) <br /> Heat pump Backflow prevente�(inside bldg) <br /> Unit heater Urinal - <br /> � Boiler � Drinking Fountain � � <br /> Refrigerafion Floor drain <br /> Woodstove Grease trap <br /> � Ducting � Roof drains � � <br /> ! Other Medical Gas <br /> �PFb1iP�G�I��� / ��DP6��I���d�Fd ���`���11I . � Other: <br /> Number of Heads Other: <br /> I he�eby certify that I have read and examined this appllcation and knoW ihe same to be irue and correct.All provisions of laws and ordinances governing ihis iype of work will be complied <br /> wilh tvhe(her specified herein or not.The graniing of a pefmit does not presume to give authority to vlolate or cance�ihe provlsion of any othef siaie or local laW regulating conslruction <br /> That I am orized by 1he ownef of this property io perForm the tvork for which application is made and I comply with the Siate Contracto�s Law 1 D27 RCW and 296.200A WAC. <br /> �..J'� � —��^'� � <br /> �Authorize ntSignature Date (Revised4/2015) <br />