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A 99�tj <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/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 />APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM //i - an `I <br />SITE ADDRESS: <br />PROPERTY TAX a <br />PERMIT 'a <br />((OCGO,T <br />L <br />D / <br />LEGAL for new construction Shon PlaVsubdwision Lot No __ (attach copy of long legal description) <br />OWNER <br />Phone/E-mail <br />Address 24)e /rc <br />City/State/Zip - <br />CONTRACTOR IqZc. L&ILic.M .emu m63/a 77 GIS <br />�Sd y 73 •d d�3 x�S <br />x- /' Phone/Email <br />Address 9d9 -3• r f'O mA �' 7 O ,,.M / S•fiH <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />e7ow'f /i. G+! F+fEY <br />,C,4?37 <br />Phone/E-mail SAs'»Z JPS <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK 3J, b0O <br />Existing Use of Building HEAT SOURCE. <br />Proposed Use of Building Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family Y Commercial <br />Type of project: - New _ Addition _ Remodel _ Repair _ T.I. L Sign _Sprinkler —Demolition—Change of Use <br />Description of Work (additionalspace provided on the back)' /Q�/a! e JE E-X /JT/N !n 4JA.LL .iJ6-nJ Y J�G1yT r <br />/O/i..l��- �3Jtr`r`J /U2 //�/�J� ii/•41. T/TLF /}Na7 /N ST19LL NL-aJ <br />'• <br />L Af L, 3/6.v Yl.✓'D f24.57 •' ,2 ti , 0'N& `FiJQJ7 ig/7"TfrCi�'�1w1 7 /7tL <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteratlon_Repair <br />Tyre of Project: _New_Addn _Ahemtlw_Repair <br />Show Number (e) of Fixtures <br />Show Number (0) of fixtures <br />FVC - air handlingunits <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas ping <br />Lavato was basin <br />Water heater <br />Shower <br />I Gas fireplace <br />Kitchen sink & disposal <br />I Gas ran a <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink servicefbar/mo etc. <br />Heal pump <br />Backfiow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refri eration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />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 <br />this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give aulhonly to violate or cancel <br />the provision of any other state or local low regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to pelfo qe work for wfnch application is made and I comply with the Stale Contractors Law 18.27 RCW and 296.200 WAC <br />GAL>L�l le <br />Owner/Authorized Agent Signa Dale (Revised 2/2011) <br />(I� <br />