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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: � PAKCFL' E IT#t <br /> 5"51,x` c�S ` v�'ru�f.Q �CJe 0813 00007tioo P ;1 - ; 3 <br /> LEGAL for new construction: Short Platigubdlvigion Lot No. (attach copy of long legal description) <br /> OWNER rnR. q MeS. CAh2IS R tW0 Phune/E-mail 'y6;,6 3A49—,?04y? C'DQ L LN)53 @rm-N ►r y� <br /> Address 6 /5- Q5- 1" �11P/lQ_ �ao3 Cty/State/zlp 6-VFkET Loft- 9SaD3 <br /> APPLICANT:—owner _Owner'sAgent fn Contractor Controoter's Agent Tenant(must provldo a letter of content from the owner to do work In the tpece) <br /> CONTRACTOR CV P-1V6kSMl),C RG(JN II V C- L&I Il# CO)Qafli�1C�COE Bus. Lic.# 17��Id <br /> Address r /W Y Q� *J101 8DO)f/11 W4 ?0QWQ Phone/Emall <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT CQA1& M1,&&1; <br /> 2IXo-781v���W l <br /> Phone/E-mail 6 �Rn1E(�ST�v jZ ,t/6eL�� <br /> BUILDING PERMIT APPLICATION 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 /> T e of project: New Addition Remodel Repair TI. Sin Sprinkler, Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provldod on tha back): <br /> R2xY,ose c +r s�-'n , �r1-ca Qa <br /> MECHANICAL PERMIT APPLICATION PLUM13ING PERMIT APPLICATION <br /> Type of Project: __,_New_Addn _Afteratlon Repalr Type of Project: <br /> _New_Addn _Altoratlon <br /> _Repair <br /> Show Number # of fixtures Show Number # of fixtures <br /> A/C—air handling units Toilet <br /> Forced alr systems Bathtub <br /> Gas p1ping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&dis osal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Slnk (service/bar/mop/etc) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease tra <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 thlq nppllcntlon and know the.anme to be trvc and correct,All prow{alone of laws end ordinances governing this type of work will be compiled <br /> with whether speclfled heroln or not.The granting of n pormlt docs not proaumn to give nuthortty to violate or cancel the provlaion of any other elate or local law regulating construction <br /> That I am suthort7nd by the,owner of thh property to perform thn work for which appllcatlon la made and 1 comply with the state Controctor-4 I,nw 1$,27 RCW and 296,200A WAC <br /> Own lAuth ed Agent Signature Dete (Revised 62092) <br />