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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 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> ‘,09 A no`I - 1GDg035-oo r'_j <br /> LEGAL for new construction: nShort Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Jrz._ (2- ati Phone/E-mail 41-5 317 9 33Z- j'p2hr kit w+aHh®(—f3 her,��� <br /> Address 2Co I(e) fj cc,ac)w 1 A J Q City/State/Zip <br /> CONTRACTOR ►1 o A 2 L&I Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 1((Le)e ()V It o'j HEAT SOURCE: <br /> Proposed Use of Buildinn, 5i n 9 te le resiate)cc Gas Electric VOther <br /> Building type Single Fami _Duplex Townhouse _ 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 the back): <br /> Have you started working without a permit? YES )( NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units j Toilet <br /> Forced air systems C) Bathtub <br /> Gas piping 2, I Lavatory(wash basin) <br /> Water heater —Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> / Range hood I Water heater <br /> / Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler _ Drinking Fountain <br /> j Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify 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 will 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 local 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 application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> ` ^V. (al 17 /20i/ <br /> Owner/Authorized Agent Signature Date crfe F I 'I �y i� (Revised 2/2011) <br />