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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 I� � I I I y� i O <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� � <br />SITE ADDRESS: 00,7 W CaS�V�� � �S `� PROPERTY TAX q PERMIT # <br />3 � 28o�-�so���o�oo a��os-o�v <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER 1 �l e V�(•'�VI� �pyy�dqNN Phone/E-mail <br />Address �Oo�J � �y31�1.� 11�n <br />CONTRACTOR W��� 1 �rt 1"Y'o'}tcal0h <br />Address ( 7�21 1 ye S� S G Ste <br />�oe�� WW I P �s-�� <br />BUILDING PERMIT APPLICATION <br />CitylState/Zip �1/��-, �� q��%T <br />L&ILic.# W��FE�(�Y 6DD <br />o„,�e wA q�y�ti PhonelEmail 3�0 -?�'t- 79 26 <br />CONTACT FOR PERMIT �� Anoe� <br />L(�� 1�1 <br />Phone/E-mail � G'1 cYvl �' (�vi�►�C�tV1e v�C�qq. �O4�n <br />CONTRACT PRICE OF WORK � O� � <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas 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 (additional space provided on the back): <br />�a^�Ic ��� S�n►�1��� .��fiew, -�c�r new <br />w���e�►- -r�,6,w,� �� �� NFP� �� . <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 <br />Show Number (#J of fixtures <br />( A/C — air handling units <br />E Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes drver <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refricleration <br />Ducti <br />SPRINKLER / SUPPRESSION SYSTEM <br />T ( Number of Heads <br />of Project: _New _Addn _Alteretion _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />jLavatory (wash basin) <br />Shower <br />( Kitchen sink & disposal <br />� Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />--� Urinal <br />Drinking Fountain <br />Floor drain <br />f Grease trap <br />j Roof drains <br />i Medical Gas <br />� Other: <br />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 1827 RCW and 296.200 WAC <br />�� �� �� <br />Owner/A ized Agent Signature Date (Revised 2/2011) <br />