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r <br /> 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: PROPERTYTAX# PEWIT# <br /> q:30(4I ' W. olo-,JaoonoRo0 W 120g-00?J- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER r L(� (,(,� Phone/E-mail _ ' mad <br /> y;�S 157_ 9q (4-4)+tfa `c.i�f <br /> Address 9:30 14 r `-(-F, Ave_ t,). City/State/Zip FU4,cP 4 f OA c 71 o y . <br /> CONTRACTOR D w f,e t 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 22-755 _ 0(7 <br /> 11 <br /> Existing Use of Building Dp(' ., HEAT SOURCE: <br /> Proposed Use of Building Derck at4 Cots-eckeeM Gas_ Electric_ Other l / <br /> Y <br /> Building type: V6ingle Family —Duplex_Townhouse _Multi-Family —Commercial <br /> Type of project: —New Family/ <br /> —Remodel —Repair T.I. Sign_Sprinkler Demolition Change of Use <br /> Description of Wor (additional space provided on the back): 1 S? <br /> E70-e. i d J `('C" eAC.f 0- dee.& f0 km_ Cover de c.)E w 11-61 60,00 �1 1C.13/7 <br /> rat:,&"t euncil cover t.vn c{ex- 'tC.sz. desk Fo-, 5+0 ra3 e. r utre 054e_ <br /> Have you started working without a permit? 'BYES 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 1 Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> as fireplace Kitchen sink&disposal <br /> G. range Dishwasher <br /> Clot'-s dryer Clothes washer <br /> Range •od Water heater <br /> Exhaust fa ink(service/bar/mop/etc.) <br /> Heat pump B- kflow preventer <br /> Unit heater Urin- <br /> Boiler Drinkin• ountain <br /> Refrigeration Floor drai <br /> Woodstove 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 ork for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC 11 <br /> Al /1 g/,,Z I 1 <br /> Owner/Authorized Agent Signature Date (Revised 2/2011) <br /> J <br />