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0 0 <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: !Orlc Jq"St- PROPERTY TAX# P MIT <br /> u� 9&zor z bsr sc o r zao �_ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ry'- Phone/E-mail ZS-2S"f-3t&Y <br /> Address P.O. 60)c S3$ City/State/Zip elr# Wjl y$?mo <br /> CONTRACTOR O- »LC^,2W L&I Lic.# <br /> Address ' e �(�/ �Ji�1�tn Phone/Email <br /> tiuf�t]JN[T TENANT of 16INES NAME F-Sy DfiqGQ_; &atS/1dFa/ CONTAeT FOR PERMIT <br /> ( aa-i—S'A"o Phone/E-mail 7S-388-0&13 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building yAC4Af HEAT SOURCE: <br /> Proposed Use of Building 70– ke daww64 1W Gas_k Electric Other_ <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family X Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work New <br /> 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 Toilet <br /> Forced air systems Bathtub <br /> Gas piping 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 ( Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump ( Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> i Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I 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 /> 73Zlilla�i/r W? 1PZ_FM looff7 <br /> Owner/Authorized Agent Signature Date (Revised 212011) <br />