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��ERt�IT' APP��� `TI u <br /> �UI�DING/11�EC��NICa4L./PL�f111�ItVG/SIC�1/�PRIRIMC�ER/DENIOL,IT'ION <br /> CITY OF EVERETT P�Rli�ll' SERVICES <br /> 3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: �� �^ PROPERTY TAX# PE M T# /� <br /> i��7��{ l�/L".�'� /-r•�" � (�� 3�S' E�-�I^��I C'> � U 7�� <br /> L�GAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER(�'�C_� �!� �"-�i??=/'�� Phone/E-mail �/<'�,,; �/J � %��I_� <br /> �� <br /> Address !�>J �j.>•_� ,S""z� � City/5tate/Zip �,.vct � �� - �J ��� �1�_ <br /> APPLICANT: Owner _Owner's Agent _Contractor _Contractor�5 AgOfll _TBf18�t(must provide a lelter of consent irom the owne�lo dp work In ihe space) <br /> CONTRACTOR %� _,�,!,.;� � : �^ — State Lic,#�� Cc.<<�:�,%r�L'TL �"��`'� � City Bus. Lic.#k'j!�l`/C��'� <br /> Address Phone/Email <br /> CONTAC�T FOR PERMIT ,, <br /> ;;u.�:�-=�';�;,,1;,�-�r i�/��,J�-Y,-i��. -�h <br /> Phone/E-mail �-.53- ZO- �70�) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ? ;_� '� '�� <br /> Existing Use of Building T� � � � � �� HEAT SOURCE; <br /> Proposed Use o Building �i���`t ���`�/�� 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): ��� ����,;J,��� G�����y������G�� '�'?'-, <br /> �; -,.�...tr � � - �,.-� , - , > ; <br /> �L� �U � <br /> / '� �--/7.i, J� I � i_ �✓�.-,,,r ls N� i � .. .. ;� ` -� c/; <br /> � . — �, <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 fiztures <br /> A/C–air handling units Toilet <br /> Forced air systems j Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater / 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 /> � Ot 'er Medical Gas <br /> SPRIW'14LER / UPPRESSION SYSTEM Other: <br /> � .Number of Heads Other: <br /> I hereby ce#ify thai I have r and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this lype of work will be complied <br /> wilh elher specified he f or not.The granting of a permii does noi presume io give authority io violate or cancel ihe provision of any other state or local law regulating construction <br /> Tha I am auihorized by ; owner of this roperty to perform the Work for which application is made and I comply with the State Contractors LaW 18.27 RCW and 296.200A WAC. <br /> � � l <br /> ,' , �'-Z - . <br /> Owner/Au o i e Age ign ure Date (Revised 4/2015� <br /> � � ��v� <br /> � <br />