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PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES 6 —Q—I Z <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.evere orgt r '] <br />.oc wr•r•corcn cone n AM TO l J A PM A -0-/T <br />MIT# <br />SITE ADDRESS: <br />3/ao t°w% ✓e <br />PROPERTY T # _ <br />60 35G ao/oo <br />LEGAL for new construction Short Platisubdvaion Lot No _ (attach copy of long legal description) <br />OWNER i / e 05 �7/13/ • �nS S O C. <br />PhonelE.mal �yS^- o/ o S 7 <br />Address -T ?.IOy/G A ✓� • <br />Q <br />Cdy/Stateibp V C P(/( ((J 4 • / 00201 <br />KS <f <br />L & I Lic. # R/G Al r� M 9 8 e cot <br />CONTRACTOR r / . <br />Address PQ 7'$ 3 - 3/ /� L z✓ <br />as =335 <br />S uI PhonetEmal P17 <br />TENANT BU�SSIINE SNAME <br />CO TACT FOR PERMMIT//-rG jd <br />All1 f nA S S SO C • <br />Phone/E.mail AI-E 6 / i'14 • ��J • -��7 <br />eC 1. <br />BUILDING PERMIT APPLICATION ICONTRACT <br />PRICE OF WORK = 80 0 - &V <br />HEAT SOURCE; <br />Existing Use of Building <br />✓Electric Other <br />Proposed Use of Building Gas 41 <br />Budding type Single Family _ Duplex _Townhouse _ Multi- an..l^ _ Commercial <br />_ <br />Type of project _New _Addition _Remodel _ Repair y_ T.I. _ Sign _Sprinkler —Demolition—Change of Use <br />Description of Work (additional space provided on the back) 6W 1�,i6 L. lxi4G / y <br />Have you started working without a Permit? ✓ YES _N a /1L O <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Addn _Alteration _Repair <br />Al t eation —Repair <br />Type of Project —New dn -.Alteration <br />_New <br />Show Number (#) of fixtures <br />Show Number fi es <br />Toilet <br />AIC - au handling units <br />'�— <br />Bathtub <br />Forced air s stems <br />Lavatory(wash basin) <br />1.9 Gas piping <br />_ <br />_ Shower <br />Kitchen sink 8 disposal <br />Water heater <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes d er <br />Water heater <br />Range hood <br />No <br />Sink (service/bartmop/etc I <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Fountain <br />Drinking <br />Boiler <br />Floor dram <br />Reftieration <br />Grease trap <br />Woodstove <br />Roof drains <br />DUChnq <br />Medical Gas <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />Other <br />I hereby cen,fy 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 wit 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 Zonal 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 appl aron is made and I comply oath the State Contractors Law 18 27 RCW and 296 200 WAC <br />nub <br />Ow (Revered 1/I011) <br />(Authorized Agent Signature Date / <br />1 \/ <br />v <br />