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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 ADD$ESS: vG 'Sic. A 4� PR0643PERTTAX i! O O P MIT#_ <br /> LEGAL for new construction: Short Plat/subdivision Lot No.___ (attach copy of long legal description) <br /> OWNER 3 I10 d ` Phone/E-mail 7-5'- <br /> Address:24Q A' /'y4 IT1Ce1�� City/State/Zip V �,' wA <br /> CONTRACTOR M �>j("� J sttS L&I LiC.# -3 Z <br /> Address ( LO -ON WL Phone/Email b&'$S SM%-t' ist. •Cgw, ;IL-C '74003 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �,Aq MLZ��GCi� -6Qv-,V- 1t1I�s. VO." Sfe:St CSFS <br /> e 1t� Phone/E-rnail ! M .C.At,, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 2e t..11 5 e.1I HEAT SOURCE: <br /> Proposed Use of Buildingl0.hk 9rp,4-4, Y 041yC. Gas_ Electric_ Other_ <br /> Building type: _Single Family _Duplex—Townhouse _Multi-Family X Commercial <br /> Type of project: _New _Addition _Remodel _Repair XT.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additio al space provided on the back): t �`+�� ,`} �� �w 4%.v---t <br /> %v 't <br /> 0jaX is.4LStcwdlL a SyS w—w <br /> Have you started working without a permit? _YES )CNO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn jLAiteration_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 airs stems 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 /> Refrigeration Floor drain <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 wo k fo ich application is made and I comply with he State Contractors Law 18.27 RCW and 296.200 WAC <br /> 1*rq-oAP61 3 <br /> Owner/Authorized AVAnt Signature Date (Revised 2/2011) <br />