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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: PROPERTY TAX# PERMIT# <br /> Ave Ll54s0 t 0000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ��'la ? lZ� Phone/E-mail Lk217 . L 3 7jI 0 l <br /> Address (t'l'_ S Cj.F 1\1E- City/State/Zip)41-A 12-`- `:) •C E � f! 1 6-Z-11 fl <br /> CONTRACTOR 0*L P L& I Lic. # <br /> Address .A 0/1 E Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK `jr Da(' <br /> Existing Use of Building Ley-'L.1e._ �ia�`�t��� (\t�tc� t^NLL HEAT SOURCE: <br /> Proposed Use of Building t C , �t�t1�y `ji t kt C-t Gas Electric K Other <br /> Building type: < Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project: New Addition Remodel X Repair T.I. Sign Sprinkler Demolition Change of Use <br /> Description of Work(additional space provided on the back): c_k L n5 010,- ` 1 u1 1/4‘-'e" t11-'Cc'r`osr- d 06 r5 <br /> -- 32.." (n)S t' 1 lAV..c\ -kvo1,, v tc q►v- J <br /> t P 5 1 � 'P�r�11cs,r, Ar1v� Q{�iC, ' 't"S oc4c <br /> r(05 � iN ��rc�✓� C7vvl ) re_0,10v< bC1ttWt.NLy� ChAlEt e(.t T R°eQdet Ftec k's seers ihi<A9`r`.,1 <br /> Have you started working without a permit? YES X` NO -rretyh (e rto/Al c Nc� S�rilf CkCev'ev' <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 j Bathtub <br /> Gas piping { Lavatory (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink &disposal <br /> Gas range Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood { Water heater <br /> °L Exhaust fan I 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 /> Owner/Authorized AgentIgnature Date (Revised 2/2011) <br />