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r'ERMIT 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 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX ft PERMIT# <br /> IC'. t. 7. P/1IV:tl\'0v V,e,..,% .1")li„L EI/'L'.c r 2,:'(..)`--,:7! -ou /24't1c/ J /l G' l ` 0D� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER y P e L.l( til► + Phone/E-mail '2,4)(,:. -j''-i ,.�3L) /C'(i l Date NNd/Merdd <br /> Q c> •c c+m <br /> Address 10 t t- ,►$ .kyr c. D.-to# City/State/Zip 1:L L C:,--IT LL. i4j tS Z.�3 <br /> CONTRACTOR L& I Lic. # <br /> Address Phone/Email <br /> TENANT BUS4 ESS NAME CONTACT FOR PERMIT '2. ) r 4-f (� /S <br /> v Phone/E-mail LC'(^. •z)r1 ( <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��j <br /> Existing Use of Building tjJ� ,./ SeAtk. ;"1 r4 :=_i tLr t,,.) t z.,(_A-.\`) HEAT SOURCE: <br /> Proposed Use of Building St4N\C- 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/rk(additional space provided on the back): <br /> ,,n „IL a <br /> i <br /> Have you started working without a permit? _YES ✓ NO <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 iToilet <br /> Forced air systems 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 <br /> Unit heater Urinal <br /> _ Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other (%it'i Cys C i�uf),1Nj.tyMedical Gas <br /> SPRINKLER/SUPPRESSION SYSTtM Other <br /> Number of Heads <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 authority to violate or cancel <br /> the provision of any other state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to perform th�work f r which app' ati is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> .74114, <br /> it: '7Z77( il.ek //R)/20/i <br /> Owner/Authorized Agent Signature Date (Revised 12/2010) <br /> )I2,, <br />