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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUM131NG/SIGN/SPRINKLER/UEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.e.verettwa.org <br />PROPERTY TAX rl Rh11T# <br />lO2 <br />LEGAL for new consuucuon: Short PlaVsubdivislon <br />Lol No._ (attach copy of long legal &sca(plion) <br />OWNER �n Sip PhonelE-moll 1 <br />Address <br />ciry/smterzip <br />_ <br />APPLICANT:_P.v.tor _Owners Agent —Contractor _Conlin .iot's Agent <br />—TenantprrnHoomaormwmam Dori rnn a„,e,bmtwrkmme,p,Mt <br />nlmm <br />CONTRACTOR /V1UGtn //1hh %'li^ Slate Lie #/r'10Gfa (( jtJ (� <br />City Bus. Lic.#Q$3ip SS <br />Heiress i% (7 _ { Y'o 7L-V fr3bU <br />SG �rw Jh, S� N <br />(�Z��rU Phane7Fmei1 jr�.�-�/,,r�M„�ht� ,cow. <br />S ENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />PhonelE-mail <br />BUILDING PZRMIY APPLICATION CONTRACT PRICE OF WORK_ <br />IExlsting Use of Euilaing <br />HEAT SOURCE <br />Proposed Use of Building <br />Gas__ Efecinc _ Other__ <br />9uilding type. _ Single Family _ Ouplex _Townhouse _ Multi -Family Commercial <br />_ <br />Type Of project: _ New _ Addition _ Remodel _ Repair T.I. _ Sign -__Sprinkler Demolition Change of Use <br />D ESCRIPTI0N OF WORK (additional space providod on the back):=— __ <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Now_,Addn _Alloration _Ropolr <br />Typn of Project: _New _Adorn _Altoratfon <br />Show Number (#)or fixtures <br />_Ropair <br />Show Number(N) of ffxfures <br />_ <br />A/C — air handling units <br />I Toilet <br />I Forced eir s stems <br />I Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />I Gas fireplace <br />Kitchen sink & disposal <br />Uas range <br />Dishwasher <br />Clothes dryer <br />CIO he washer <br />Range hood <br />_ <br />Water heater <br />I <br />Exhaust fan <br />Sink (servicO/barlmoplelc.) <br />Heat purnp <br />Backflow prevonter <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />I <br />Woodstove <br />Grease trap <br />Dueling <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER 1 SUPPRESSION SYSTEM <br />Other. <br />Number of Heads <br />I <br />Other. <br />I hrrnby rndd, that I hmi, mad and nnmkeM 11th ppp!iedinn and know the pomo to oe eve and annct. AR pr titan, of ti r rind ordinonxa fla cmina lhl, rypn of woM wa I . mmpfxd <br />IRA O.r ppedfhdf rein tvnot. rrm of penna doe, rM faneomm I:r 9W wtno i, to vmuln wr o,,f tho pro lldn of cay MMr=:n of fowl law regulatfny ron3truGbn <br />Thal 1 am authwirsd by Oo mmer or atb ptopefty to perrotm lea MM far wnldl aDPXM oa Is made and 1 mrri wllh the State Comm lM Law 10.27 RC W and 296 200A WAC. <br />S av - Is <br />Owner/Authorized Agent 319nolure Dale (Revised 3120f3) <br />