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9 t <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />32nn Cedar St Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — wwW.everettwa.org <br />Aom rrnTtnuc Ali ArrFPTFn FROM 8 AM TO 4 PM I `" �/ 2 <br />SITE ADDRESS: �L <br />3/e20 ee�i7! e. <br />ROP RTY T x <br />POC�5 S� Da/ao <br />PERMIT x <br />,2t1 I Oz <br />LEGAL'e• ne'x wnsiructon Short P1a1jsubd1mson _ Lot No _ !attach copy of long legal oescnpuonl <br />OWNER & if 001 f/_ 19S,5n (' - <br />Phone/E-mail a - AY - 6.5 <br />L4 <br />A G0/(U <br />k'Ro / <br />Qtyl$tate/Zo ef ✓elrtffl W <br />ti,Tess / ty 1,ii. <br />CONTRACTOR f 1, �5 eP1f YV of <br />D <br />L8ILic # jx6 r7 �r7 6 <br />A:o �4 758 A A 13 ' /3 ✓e N� L a P S fP✓Cvs lJ PhonerETaii �a s- 335 - Vito <br />ess <br />TENANT BUSINESS NAME CUNT CT FOR PERMIT 7- w p /1 f0. . n �Oal • ' <br />C'ox Phone/E-maMa Ii K C P� s - 8isi <br />; $-S O e . r <br />111pdt <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK 4 60Q <br />HEAT SOURCE <br />Existing Use of Building <br />L <br />Proposed Use of Building T r Ce _ ✓ Gas Eleatic _ Other <br />Building type. _Single Family _ Duplex —Townhouse _Multi• amity _Commercial <br />Type of project _ New _Addition _ Remodel _Repair _T I. _ Sign _Sprinkler _Demohhon_Change of Use <br />Description of Work (additional space pmwded on the back): <br />Have you stalled working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ _Addn _Alteration _Repair <br />Type of Project _New_Addn _Alteration _Repair <br />Show Number (0) of Ic lures <br />Show Number (N) of fixtures <br />A •L - air handtin units - <br />_ Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatn (wash basin) <br />Water heater <br />Shower <br />Kitchen sink 8dbp05al <br />an a <br />Dishwasher <br />es dryer <br />rClothes washer <br />r=Gasireplace <br />a hood <br />Water heater <br />ust fan <br />Sink (service/barmOp!etc)) <br />pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Rein cation <br />Floor drain <br />Woodstove <br />Grease trap <br />�%— Uuctmq <br />Roof drams <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />Other. <br />! CJ7s <br />I hereby certify that I have read and examined th:s apPiication and knew the same to be we Znd correct All previsions of laws aru ordinances governimj <br />th.s type of work wel be complied wth whether speofied nerem 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 1=1 law regulating construction or the performance of constn cton That I am authp etl by the owner of this property <br />to perform the wc'k for wruch apple tern is made and I comply with the State Contractors Law 18 27 RCW ind 296 2D0 WAC <br />�Re�l a <br />Ow crlAuthorized Agonl Signature Date aed 7R011) <br />