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�ERMIT APPLICATIUIV <br /> BUILDINGJMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDRESS: -� _, PROPERTYTAX# PERMIT /� <br /> irJC [c.J �vE^ l,l - �� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of Ibng legal description) <br /> OWNER � �� .�� Phone/E-mail �l�S-3�%J-lv y,� <br /> Address � �G � �f City/State/Zip %�z,.�� � �j� <br /> APPLICANT: l�wner _Owner's Agent _Contractor _Contractor�5 A92f1t _T2fl8111(must provide a letler of consoN from the owner to dn work In ihe space) <br /> CONTRACTUR �W�Z ,.— State Lic.# City Bus. Lic. # <br /> Address Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building s%orC;, Q HEAT SOURCE: <br /> Proposed Use of Building �cic.�,vc�i� STv������ 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): <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 fixtures <br /> A/C—air handling units j Toilet <br /> Forced air systems i 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 /> i Unit heater E Urinal <br /> Boiler ; Drinking Fountain <br /> I Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I Ducting j Roof drains <br /> I Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j Other: <br /> j Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whet��Re erein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other staie or local law regulating construction <br /> I am autho' ed by the own f this property 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 /> � ��'_ <br /> O ner u horized gent Signature Date (Revised 4/2015) <br />