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������ ����Q���� �� <br /> �����I���������0���������I����I��������I�����������0���� <br /> � CITY OF EVERE7T P�1�1�11T SIER1/10E:� <br /> 3200 Cedar St., �verett, WA 982�1 425-257-8810 FAX 425-257-�3857 www.everettwa.org <br /> � � ������� <br /> SITEAD�RESS: L � v � PROPERTYTAX# F�2MIT �Q�,� <br /> f, ,1� <br /> L�GAL for new construction: Short PlaUsubdivis on Lot No. (attach copy of long legal description) <br /> OWNER ` ti � �v C Phone/E-mail <br /> ... <br /> Addfess City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent �Cont�actor _Contractor's Ag ( ._Teflaflt(mus�provlda a IeRer of consent irom 1he owner to dp work In the space) <br /> CONTRACTOR �• , � I ti C . State Lic,# ((iC�7 l�� r '�Z��� City Bus. l�ic.# <br /> Address �� C��� pZ ' � � S f U- • ,��'�� � 1�J�' Phone/Email <br /> CONTACT FQR PERMIT <br /> Phone/E-mail <br /> i <br /> BUI�DING PERMIT APPLICATION coNTr�acT PRIce oF wo�tK <br /> Fxisting Use of Bullding HEAT SOURCE: - <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: �Single Family _Duplex_Townhouse _Muiti-Family ____Commercial <br /> Type of project: _New _Addition _Remodel _Repait_T.I._Sign,_.Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additiona!space provided on the 6ack): � <br /> � � . .., �: :� , ti � E�;.��-;►�(� c �� �� 1 �� �+ �-� � �� b� ; <br /> �,�vl� 1 � � o .� o �— J <br /> �� l � � � n U ���� `��� <br /> c� �- �1��; o�� ��� �� ���� �' � L1 � �-� �c � ��t <br /> MECHANICAL PERM17 APPLICATION PLUMBI G PERMIT APPLICATION <br /> Type of Proje�t: _New_Addn _Alteration_Repair Type of Project: _New_Addn ^.Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fxfures <br /> A/C—air handling unifs l'oilet <br /> Forced air systems Bathtub <br /> Gas piping L.aVafory(wash basin). <br /> Water heater Shower <br /> Gas fireplace Kitc;hen sink&disposal <br /> Gas range Dislhwasher <br /> Clothes dryer Clo�thes washer <br /> Range hood Wa�.te�heater <br /> - Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflov✓preventer(inside bldg) <br /> Unit heater llrinal <br /> � Boiler Drinking Fountain <br /> Refrigeration Floor drain . <br /> Woodstove Grease trap <br /> ► Ducting � RooFdrains . <br /> � Other Medical Gas <br /> SPRI?�I�LEi� / SUP6'R�SS901d ��S'T�M Other: <br /> Number of Heads �ther; <br /> I herepy cerfify that I have read and examined ihis appllcation and know ihe same to be true and correct All provislons of laws and ordinances governing ihis type of work will be complied <br /> wiih whether specified herein or not,The graniing of a permit does not presume to give authority io violate or cancel ihe provision of�my other staie or local law regulating consiruclion <br /> That I am authorized by the own r of his property to perform ihe work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.20oA WAC. <br /> Owner/Authorized ature Date (Revised 4/2015) <br />