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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-24 Wet iae. 0120 .O//yt PROPERTY TAX# . RMIT <br /> art)WR d 7- VMS/retVie zGb l 7-04-00 <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> OWNER Ibr(-e(Everett Phone/E-mail 4tZS-ZSR--3/lsf <br /> Address AO. 604 $3$ City/State/Zip Everett wit ir204 <br /> CONTRACTOR 7,5 b do rstIdiad L&I Lic.# <br /> Address 15 �� {� t )�r /� ` � Phone/Email <br /> NAME r-r��1 Pro«�d Q,,:/,J,•__ CONTACT FOR PERMIT � � w�,{q,�{ <br /> 15u.t�i s'�`^..`'J <br /> QM.d 5rJu:>ELl.edrtjf'S ( jv-nt -) Phone/E-mail 412-S---381-06,(3 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK TS <br /> Existing Use of Building Va.CA - HEAT SOURCE: <br /> Proposed Use of Building T be. did'tp444.Ld Gas X Electric X Other <br /> Building type: _Single Family Duplex_Townhouse _Multi-Family X 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_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater • <br /> I 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 I 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 goveming <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 /> -52'afiai!?7L2'L�er Fall.PO TaF8)&Refi Y/11�lz <br /> Owner/Authorized Agent Signature Date (Revised 2/2011) <br />