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•����a� ����a�����,� <br /> ��'������������o���������'�����������a�����������s�w�� <br /> � C1TY OF EVEREI'T P�RiVIIT' SIERVICES <br /> 3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERIYTAX# PERMIT# <br /> ,�Q 's � i�ti-� � 2 r�,H �c • � c�> �c; l�i C� --C�,L' <br /> L�GAL for new constrUction: Short Plat/subdivision �'��`".������d y�- Lot No. (attach copy of long legal description) <br /> � Phone/E-mail �V�•� ��I"l- -[ S SZ <br /> OWNER . • <br /> Address � �,c, � � - � City/State/Zip -' +Z,�'�•' ' r e- 7� �:u <br /> AFPLICANT: Owner _Owner's Agent ^Contfactor _Contractor's Age�t _Tenant(must provida a lener of conssnl from the owner lo dp w❑rk In�he space) <br /> CONTRACTOR �,• `, .�;1� aJ C��'✓�J�.:� State Lic.# City Sus. I.ic.# <br /> Address • Phone/Email <br /> CONTACT FQR PERMIT •� <br /> , I�MG�� 1'��'� ��-��,�t: I-�t�.,�. <br /> � <br /> ���tv����� 1/�S�� Phone/E-mail L� ' �� " .�.5� �� Si: �` �"� l`u r" <br /> BUI�.DING PERMIT APPLICATION coNTr�acT PRice oF woR►t �b �J��r� -- <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric other <br /> Building type: ,_Single Family _Quplex_,Townhouse _Multi-Family �Commercial <br /> Type of project: _New ,_Addition _Remodel _Repair_T.I._5ign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTI�N OF WORK(additional space provided on the back): / <br /> '� ✓/{' � ^ `� 0 � �- �'IJJc� <br /> . 4' I��Y�` ��� �" L'� / �l��� �I/ `�� <br /> �� � � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type�f Project: _New_Addn _Alteration_Repair Type of Project: _,New_Addn �,Alteration_Repair <br /> 5how Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavafory(wash basin). <br /> Water heater Sfiower <br /> Gas fireplace Kitchen sink 8�disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> � Exhaust fan Sink (seNice/badmop/etc.) <br /> Heat pump Backflov✓Preventer(inside bidg) <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 /> SPRINF�l�ER / S�J�'Pff�IESSBOBd S�(S7EM Other; <br /> Number of Heads Other; <br /> I hereby cerfify ihat I have read and examined this appllcation and know ihe same 10 be true and correct All provislons of laws and ordinances governing ihis lype of work will be complied <br /> wiih whefher specified herein or not.The granting of a permit does noi presume to give authori�y io violate or cancel ihe provision of any other siaie or local law regulating construction <br /> That I am authorized y 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 296.20oA WAC. <br /> l + <br /> � �' � �� � <br /> Owner/Authorize nt Signature Date (Revised 4/2�15) <br /> . /� � <br />