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�ERMIT APPLICATI� <br /> BUILDING/MECHANICAL/PLUIV�BING/SIG�I/SPRINI�LER/DEMOL,ITI�N <br /> � CITY OF EVERETT P�RMIT SER�/ICES <br /> 3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.Qrg <br /> SITE ADDRESS: PROPERTY TAX#1 P RMIT# <br /> �L/z � ���, . ����3�s�_�Z�?_��� _�� I o7- c� <br /> L�GAL for new construction: Short Plat/subdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER C/�/�Jj �rpU�,�' �y, Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT: Owner _Owner's Agent�COfltfaCtOf _Cofltl'aCtO�'S AgBflt _Teflaili(must provida a letfer of consent from the owner to dp work in the space) <br /> CONTRACTOR � �~� T� � State Lic.#��ia,cL�1G� City Bus. Lic.# <br /> Address Phone/Email <br /> CONTACT FQR PERMIT yzS��y�_3�6� <br /> Phone/E-mail � • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK %o ��U <br /> Existing Use of Building �/�i � h,. � � cn i�� HEAT SOURCE: <br /> t � y� � ' � <br /> Proposed Use of Building ��l/' ��v /L�3'�'��.�/a � Gas_ Electric_ Other <br /> Building type: ,T Single Family _Duplex_ ownhouse ,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 /> //+� :,�� , �- <br /> � � ���� � ,���� i •j'M .:� 1� y.y , <br /> G"��) ' ' . <br /> ,��+* ..`..�.R�,' �'.�i�.f} <br /> e r <br /> y 1 <br /> MECHANICAL PERMIT APPLICATION PLUMB IT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: lNew_„Addn ,_,Alkeration,_.Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping l.avatory(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/et� <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinai <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> ! Du ing Roof drains <br /> � O er Medical Gas <br /> SPRINKLER /, UPPRESSION SYSTEM Other: <br /> - .�Number of Heads Other, <br /> f �� <br /> I hereby Geltify that I ha6e ad d examined this applicat(on and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be compiisd <br /> with ether specifie,d' rei ' r not.The granting of a permit does not presume to give authority to violate or cancel ihe provision of any other state or local law regulating construction <br /> Th authorA�e� tp owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WA0. <br /> .,�!.�,��' ��- Z 3-�-/.S <br /> Own ��1ti rized Agent Signature Date (Revised 4/201.���� <br /> �'' °�yti(2 � <br /> �.�_._...:._ <br />