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PERMIT APPLICA�10�! <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLI�'ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 wvv�N.everettwa.org <br /> SITE ADDRESS: PROPERTV TAX ii P RMIT# <br /> , � � 'Q�� <br /> LEGAL for new construction: Short PlaUsubdivision�Z.Tt�J�d�t� � Lot No.`� (attach copy of long legal description) <br /> OWNERS��}l'T(.� ��FyL ���5 Phone/E-ma;l ��'Z-� , �S 3 Z"�'�U <br /> 12� �J�r2.�-t� Wviu� �+�.� <br /> Address s J ��� (p,� City/State/Zip �Z-�f�;ciZ.Ct� ��� � c�ZG� <br /> APPLICANT: _Owner _Owner'sAgent _Contractor _Contractor'sAgent __Tenant�m�s�prov�deaieuerofconsen�trom�r,eowner�odowork�nu,espace� <br /> CONTRACTORS'��-��- �1��--1��C.- C�l'�'v��> State Lic.�j�rALT�r4���� City Bus. Lic.#�p03 Z�tiO- '(s�G <br /> Address �ji��v�n,� Fhone/Email �q�„�_ _ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas✓ Electric Other <br /> Building type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: i/New Addition Remodel Repair�T.I.�Sign�Sprinkler�Demolition Change of Use <br /> DESC RIPTION OF WORK(additional space provided on the back); <br /> � � <br /> l3P�s� L R�- � t� w ,,-�L �� 2Z�v`� - �3�� _� <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 /> �-- I AIC-air handling units 3 Toilet <br /> � Forced air systems � Bathtub <br /> 3 • Gas piping sk Lavatory(wash basin) <br /> 1 ; Water heater Shower <br /> l ! Gas fireplace Kitchen sink&disposal <br /> � � Gas range � Dishwasher <br /> � Clothes dryer � I Clothes washer <br /> Range hood 1 � Water heater <br /> � Exhaust fan Sink(servicelbarlmopletc.) <br /> Heat pump r. � Backflow preventer <br /> Unit heater � Urinal <br /> � Boiler ; Drinking Fountain <br /> Refrigeration .:._ Floor drain <br /> ,�. Woodstove I Grease trap <br /> ! Ducting � Roof drains <br /> � Other � � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> � � Number of Heads � Other: <br /> I hereby certify lhal I have read and examined lhis applicalion and know lhe same lo be lrue and correcl.All provisions of laws and ordinances governing lhis lype of work will be complied <br /> with whether specified rein or not.The granting of a pefmit does not presume to give authority to violate or cancel the provision of any other state of local law regulating construction <br /> Thal I am h zed lhe wner of lhis properly lo peAorm lhe work for which applicalion is made and I comply wilh lhe Slale Conlraclors Law 18.27 RCW and 296.200A WAC. <br /> , 3-� Z`�� <br /> Ownbi�/Authorize Agent Signature Date (Revised 3/2013) <br /> % <br /> / <br />