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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 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: is-7_0 4~ /12a-rietc Vttw .OrivL PROPERTY TAX 4 r-P RMIT <br /> Wft azo( 2/05i c3Ljor2cb 0 ILO 4-CUD ) <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> OWNER hr-t-o(Euereit Phone/E-mail 4-/ZS—7_s1-3I6,-/ <br /> Address P.O. 130 S3S City/State/Zip Eve/rt./ tom '? Zoc, <br /> CONTRACTOR To b.t_ L&I Lic.# <br /> address <br /> NAME <br /> m7iler r:6 -✓��) Phone/Email <br /> iN nN MEFL�1 Proceadcu� :e d CONTACT FOR PERMIT —' t- (- <br /> eae 5cuilte,A4 ,Iys f 6nr fl 4) Phone/E-mail X25-3a alr l 3 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Tao <br /> Existing Use of Building Vetret.it-t HEAT SOURCE: <br /> Proposed Use of Building T be_ ptG1iego Gas X Electric X Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family )c1 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 /> Have you started working without a permit? YES X. NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration Repair Type of Project: _New_Adds _Alteration_Repair <br /> Show Number(4)of fixtures Show Number(4)of fixtures <br /> A/C—air handling units I Toilet <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 Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> 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 <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 the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> L Z irC-y+!ZG a Peg_paerar EV rr 14�l <br /> Owner/Authorized Agent Signature Date (Revised 2/2011) <br /> 7 <br />