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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DERIIOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810 —FAX 425-257-8857—www.everei:twa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS- � }-�' PROPERTY T—A7X# PERMIT# <br /> ly.r Fvuet \ wA 61 f,L 5 0, I !,,# C,� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 6rC'c I(C"A47A(L: &isWVXGU✓\ Phone/E-mail —q0[ - 3-[+JY Q� �ONd1 (Z 1vl LiLS . y <br /> Address City/State/Zip <br /> CONTRACTOR L&I Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT r-trc Iv'ia (ylt'�`�Z /w- ec C <br /> Z'L 5;t- LuwlGvekiSk' <br /> Phone/E-mail F34;�}--+5- :s 7 VA"kE'.'ewL fr YL LZ'aj. Liv 1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building *:51 K�j HEAT SOURCE: <br /> Proposed Use of Building Gas_Z__ Electric-Z,- Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New Addition Zy Remodel _Repair_T.1._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additional space provided on the back): � , ,y 6 CA I Vk��t`� J �} rLe, po,J,;�z,- <br /> 1111IY(iJ�SrV u'te���� iPt�� StZC�I fwu7tLv✓ 6-4v{ K[�S�Gv' <br /> Have you started working without a permit? _YES _ZNO <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 I Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> j Water heater y 1 Shower <br /> -- Gas fireplace 1 Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer ( Clothes washer <br /> ¢ Range hood <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> INumber of Heads I 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 ap ication is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> Owner/Authorized Agent Signa ure Date (Revised 2/2011) <br />