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NOV/04/2(]16/FRI Ol ; 02 PM Nort�ree[c I�oof ing FAX No, 425 48�24 <br />�� <br />P, 002 <br />PERIVi�T APPLI�ATIQN <br />BU1LDfNG/MECHANlCAL/PLUN'IB1NG/S1�N/SPR�NKLER/D�MOLITION <br />CITY O� ,�V�R�TT PERMIT SERVIC�S <br />3200 Cedar St., �vereEt, WA 98201 425-257-881 D FAX 425�257�8857 vwvw_everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SIT�ADDRESS: /J (�}� C�`__�� S� PROPERTYTAX►S fi� _ <br />!� � '` C � ` <br />LEGAL for new const�udion: short PlaUsubdivision LoE No. (attach copy of lonr� legal description) <br />�WN�R � —! �i/_l�li� li1 "e�UV �Q., Pnone/�-mail 1 �rI) � 7;� ,�*�, "` 0.�� 0 <br />IA�dress ✓� �� � CitylStatelZ+p <br />APPLIGAJ�lT;, _ owner _ Owner's f�ant Contractor _ Contractors Agent _ <br />CONTRACTOR ' O � L � L& E Lic. # <br />Address ��1+.0_\��1"``�\ V �.� V (� �,v� � 1,\U �"����2 <br />BUIl.DING PERM�T ,APPLICATION <br />� �. U � <br />Te�anf (mvsipm�0a a fetterorwnaent Rom the ov,�,ert❑ daworh Sn �,a;pa�� <br />�� - o o �o� B�s. �«. #,63Z��t f <br />Phone/[rnail �����3 -� �"� `p <br />R PERMlT p/�. ��r�� � <br />V� <br />i7M9�i1 Il7r! � ILAI(�/�C!'�.e.�t�p -U <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />Proposed Use of Buitding <br />Building type: �Single Fami[y _ pu�le,x_Townhouse _ Mu1ti-Family <br />Type of projecf: New Addikion � F�emodel R2pair TJ. : <br />DESCRIP7'10N OF WORK (add�tional spa ec provided on tHe 6ackJ: <br />��-�'`� � �`? � ��''t�.4� vv,� c.��� . <br />MECHANICAL PERM[T APPLICAT[ON <br />of ProJect: _Nsw_�4ddn _Altaratfon_Rapair <br />ShawNumber (#) off�ures <br />� A/C – air handling units <br />Forced air svstems <br />Water heater <br />Gas �replace <br />Gas range <br />Clothes dryer <br />Ranqe hood <br />Exhaustfan <br />� I Woodstove <br />� Other <br />SPRINaC��R / SUPPR6S�ION SYSTE <br />� Number of Heads <br />HFAT SOURCE: <br />Electric � <br />CommerCial <br />_5prinkler Damolitior� Chanae of Use <br />PLUMBINCr PERNIE7 AP�L.[CATION <br />Type pf PrOj9ct: _NBW _Adtln _Alteraiion _Re�9€r <br />ShowNumber(tl offMurss <br />� � Toilet <br />� Batritub <br /># Lavatory (wash basin} �� <br />Kitchen sink & disposaE <br />Dishwasher <br />Clothes washer <br />Sink (serviee/bar/mo <br />8ackffow praverlter <br />Urinal <br />Drinking Fauntain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medica! Cas <br />O�her; <br />Other: <br />I hsre�y certify Ihat I nava raed entl examineQ Ws applicalion antl know t}�e sams lo be irv� and carrect. All provis(ons oriaws antl orc��nsnces goveming Ihis rypo of woric will be comp�rea <br />wifh whetherapecfAed herein ornoL 'Rie granting of a permtt does no( pres�me l0 4��s authonty to vfolate orcancef the provlston of any otner state or local law rogulaU�a consWction <br />it��t I am euthorized by the owner of this Droperty to per7orm tbe wortc forwn�cn appucs60n is mads and � wmvy with �he State Contractura Law 16.z7 RGW a�d 298200/� `�/AC. <br />1 • - ( ' 1 lA <br />wner/Authorized AgenE Signature Date <br />�� (Rav/sed 62012} <br />