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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: <br />PROPERTY TAX# <br />PQRMIT a/ _ D/ <br />LEGAL for new construction: Short Plattsubt ivision Lot No._ (attach copy of long legal description , <br />OWNER kfA,J f .TGrr. Acub O <br />Phone/E-mail <br />Address <br />City/Stale/Zip <br />CC <br />CONTRACTOR rat 1 i <br />L& I Lic. # t, n I L `i . Y _ <br />Address Jill qr l.tt(C NVC G'Vd re 4F A 9 ,ZO? Phone/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT (�A t+ (3 er- tC <br />Phone/E-mail Z S'67U-72efi <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK f6 41 o o 0 <br />Existing Use of Building >_"� HEAT SOURCE: <br />Proposed Use of Building �.} L IZ Gas Electric Other <br />/ <br />Building type: �1 Single Family „}��uplex _Townhouse ­Multi -Family -Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair X T.I. —Sign _Sprinkler _I>emolition_Change of Use <br />Description of Work (additional space provided on the back/: ReelAcc. u•AzldfdS r NGd CAh,nx-r5, 91vr4b,n) Fly-}bvt <br />�Imr coUu,nbs * Cot-n+uTOPS <br />Have you storied working without a permit? _YES 1—NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Now_Addn _Alteration _Rcpalr <br />Show Number(S) of fixtures <br />Typo of Project: _Now _Addn _Alteration y Repair <br />Show Number (#J of fixtures <br />A/C — air handling units <br />I <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />I <br />Dishwasher <br />Clothes dryer <br />I <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodslove <br />Grease trap <br />Ducting <br />Roof drains <br />Other _ <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <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 compiled with whether specified herein or not. The granting of a pennll does not presume to give authority to violate or cancel <br />the provision of any other slate oEWcal law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform the work f plic tion Is made and I comply with the State Contractors Law 10.27 RCW and 296.200 WAC <br />Owner/Authorized Agent Signature Dale (Revised 22011) <br />