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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 />SITE ADDRESS: r <br />(71'), 1"— <br />PROPERTY TAX <br />P MIT9 <br />15 b 3 - Ovs <br />LEGAL for new construction: Shari Plallsubdivision Lot No._ (attach copy of long legal description) <br />OWNER ZLyr,F,C /c I. 4 , ,{ I <br />Phone/E-mail <br />i. <br />r Address 7 ( 2 a � SY ^� �V \ <br />Ciryislatelzip &,C4,�Jj v.A 9 ff z U <br />APPLICANT: Owner —OwnersAgent _Contactor _Conlraelors Agent _TenantnrovWoarener ormmam aom mo caner mca won In ma spautl <br />CONTRACTOR /y UC,n 12/r U r'xl <br />7(mpusr <br />Slate Lic. # MDC/� f I A' 3,J (� City Bus. Lic. # 05 3(a S $ <br />Address )75r 5 y( �5} SC �jrw inn: [, I !D L,/ A G` ZCfU <br />S <br />hole Email I�Cn•r Mr,Cn �lw-,7rr. co.s. <br />[ENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric_ Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family _Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair T.I. Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on file back); <br />:Fr fJ-C, 11 I), f. k,-� I c ,on �Iv>si d T <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project: _Now_Addn _Alteration,_Repair <br />Show Number (#) of fixtures <br />Type of Project: _Now_Addn —Alteration _Repair <br />Show Number (ll) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced air systems <br />I Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heal pump <br />Backgow proven(er <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refdgcralion <br />Floor drain <br />Woodslove <br />Grease trap <br />Oucling <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER <br />I SUPPRESSION SYSTEM <br />Other. <br />Number of Beads <br />I <br />Other: <br />hereby cenny that I have read and emmined this application and know the same to be Irue and mrred. AD provisions of laws and ordinances governing this type of work wiz be compped <br />wall "other sped herein or nor The granting of a permit does not presume to give aulhemy, to violate or cancel the provhlon of any other stale or local law regubaing c nstmdon <br />Thal I am authorized by the owner of alls property to pedoml the work for whien appllcntlon Is made and 1 comply wdh the Stale Contractors Low Ia.27 RCW and 296 200A WAC. <br />Owner/Authorized Agent Signature Data <br />(Revised 3,2013) <br />