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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evtrell, WA 98201 -425-257-8810-FAX 425-257-8857-www.everett�wa.orp`'� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� <br /> PROPERTY TA%p RMIT <br /> SITE ADDRESS: ^CI7 <br /> � e� � <br /> ' Lol No._ (attach wpy o��ong legal descnpllon) <br /> LEGALfornewconslruction: ShortPlatlsubtlivision — <br /> OWNER � � PhonrJE-mail (:`5� ���" � <br /> . . I +� ' CirylState�Z�p . I 1 C � <br /> Adtlress 1,V <br /> CONTRACTOR U�l S (D G L 8 1 Lic.# <br /> P�oneJEmail <br /> ddmss <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Re Q.�"�5 �a(�( � PhanrJE-mail <br /> BUILDING PERMIT APPLICATION <br /> CONTR4CT PRICE OF WORK d'�������-��� <br /> �1�K'�f HEAT SOURCE: <br /> Exis�ing Use of Building — <br /> Gas Electnc_ Othe�_ <br /> ProposedUseofBuilding P�K /� 'r.�Mi'`� <br /> Buildingtype: _SingleFamily _Duplex_Townhouse _Multl-Family ZC Ccmmercial { Ma�TI <br /> TypeofproJect: _New _AJdition �Remodel _Repair_T.I._Sign XSprinkler._Demolition_C�ange otUse <br /> Description of Work iadpdIonal spaco providetl on Ne bacp: J ;� I �� 1 <br /> En�i*tL fl,e L�ia�*J h�'�"��t 7�1'�,� 'ft teuv� ti.e n+:fi�iuu+ 'V` N'atU- <br /> Havo you slarted working without a permit7 _YES ,�NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Pro ect: ,_,New_,Addn _Alteratlon_Repalr <br /> 7ypeofProJ:cL• _Nmv,_Addn _Allcratlon_Repalr , ShowNumbe�(N)olflrtures <br /> Show Numbcr(n�ol Ifxfuies Toile� <br /> � NC—air handling units � Balhlub <br /> � forced air s slems <br /> � Gas pipin Lavato (wash basin) <br /> � Waler heater � Shower <br /> Kikhensink8dis osal <br /> � Gas Greplace Dishwasher <br /> Gasren e Cblheswasher <br /> � Clolhes d er � Water heater <br /> Range hood � Sink(service/barlmo lelc. <br /> Exhaustfan I <br /> Heat ump Backflow reventer <br /> Unit healer Urinal <br /> Drinkin Fountain <br /> Boiler Fioor drein <br /> Refri eration � Grease tra <br /> � Woodstove Roof drains <br /> Duclin Mediwl Gas <br /> � Olher I <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> �, � NumberofHeads I Olher: <br /> I hereby cetlify ihat I taw mad and examined this applicalion and knmv tha same l0 6e trua and correct.All pmvis:ons af laws and obinances goveming <br /> ths type ol�wrk will b^wmplied with whMher specificd herein or not.TTe granling ol a permit tlocs nct presume to give authonty lo violate or wncel <br /> the provision ol any other slata or locai law regutating wnstru=tlon ur the pedemtanco ot conslruciion.Thal I am aulhonzed by lha owner of this prope�ty <br /> /to\pedorm tho work br which applicalion is made antl I comFN wilh tho Slate Conirac(ors Law 18.27 RCVJ and 29F 200\NAC <br /> l l�/ un �,'rh�,� �l`]�� fRevised 7/2011) <br /> OwnedAuthodzed Agent Signatum �a,e / <br /> �) Z <br />