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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 Phi <br />SITE ADDRESS: <br />1q* Atl 0 <br />PR PERTY TAX p .29mg.apl{-�51� <br />r . o — - <br />PERMIT <br />Atq60 - r11-17 <br />fly <br />LEGAL for new Construction-. ShortPlat/subdivlsion_f! A 1 Y MM Lot No. (attach copy of long legal descript can) <br />OWNER rMIJA '�rOM6F rAffiRM UZ <br />Phone/Email -22"X IMI jSSftreMd1 <br />ddress 12 I <br />Ctly/State/Zip <br />APPLICANT: ✓Owner Owners Agent Contractor Contractors Agent Tenant lmosr worAea exrormnumeom me awrwmoo vartnme rpa:el <br />CONTRACTOR 5W <br />L & I Lic. At COE Bus. Lic. At <br />Address PhonelEmad <br />TENANT BUSINESS <br />�JNAME <br />�t'�Y', �%�Q�/��J <br />1 FVrQW TL �'^�+�✓ <br />CONTACT FOR PERMIT 7M AMUCTO <br />Phone/Email `J a—AI"GI1C0 <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK_ <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building SELF SMIZ SRAW Gas_ Electnc_ _ Other_, <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family Commercial <br />Type ofproject: New Addition Remodel Repair T.1. Sin Sprinkler Demohtion_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />a"5I144CT 41 bF A 2- s'f y S6 i" 97W0 91414010b <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (a) of fixtures <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (A) of fixtures t <br />A/C — air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />u <br />Gas piping <br />Lavatory (wash basin) <br />I Water heater <br />I Shower <br />I Gas fireplace <br />I Kitchen sink & disposal <br />IF <br />I Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />I Water heater <br />Exhaust fan <br />Sink (service/bar/mopletc.) <br />Heal pump <br />Backflow preven;er <br />Unit healer <br />Urinal <br />Boiler <br />Drinking Fountain =! <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease [rap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />i Other: <br />I hereby cendy that I have read and emmineo this appl"ition and know the same to be true and coned. All provisions of laws and ordinances goveming this type of work will be complied <br />wah whether speared herein or not. The grammig of a permit does nor presume to give authority to v101ale Of cancel the provision of any other state or local hrwregulating consoucbon <br />That I am au0orited by the owner of this property to perform me or, lot whch nppbcauon is made and I campy with the Slate Contractors Law fit 27 RCW and 296 200A W AC. <br />qj� <br />Owner/Ruth riz ent Signature Wale <br />0M <br />(Revised 611011) <br />L <br />