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������ ����������� \ <br /> ��ll��t�@9/���9 ■��I���I! ���qR�l�@9/���Ilr/���t�69������ltl�'�i�l�/�� <br /> CITY OF EVERE7T P�RA/111' SERVICES <br /> 3200 Cedar St., �verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERN TAX#i PERMIT# <br /> • . ��/i7d���� ��� E�'L'� <br /> L�GAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/5tate/Zfp <br /> APPLICANT: Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant{must Provida a leuer ot�onsent from�he owner to aa woric in�he spa�e� <br /> CONTRACTOR State Lic,# City Bus. Lic.# � <br /> Address Phone/Email <br /> CONTACT FqR PERMIT <br /> Phone/E-mail ' <br /> BUILDING PERMIT APPLICATION cONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE; <br /> Froposed Use of Building Gas_ Electricy other <br /> Building type: ^Single Family _Duplex_Townhouse _Multi-Family ^Commercial <br /> Type of project: New _Addition _Remodel _Repair_T.I._5ign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): � <br /> �.--�:��.', +�- -- - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn ,_,Alteration_Repair <br /> 5how Num6er(#)of fixtures •Show Number(#)�df�ztures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin). <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes drye� 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 /> [ Ducting � Roof drains <br /> � Other Medical Gas <br /> SPRIf�KLER / SUPPRESSIOId SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify thal I have read and examined this application and know the same to he true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> wiih whether specified herein or not,The granting of a permit does noi presume to give authority io violate or cancel ihe provision of any other siaie or local law regulating construction <br /> That I am auihorized by the ownet of this property to perform the work for which application is made and I comply with the State Contraciors LaW 18.27 RCW and 296,200A WAC. <br /> OwnedAuthorized Agent Signature Date / � JJ 1 (Revised 4/2015) <br /> �b� ����� � � � <br /> �� , <br />