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PERMIT APPLICATION <br /> BUILDINGlMECHANICAL/PLUMBINGISIGN/SPRINKLERfDEMOLITION <br /> CITY OF EVERETT PERMIT SEt2VICES <br /> 3200 Cadar St., Everett, WA 98201 -425-257-8810-FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �I� �� <br /> SITEADDRESS: PROPERiYTAXp p RMIT# <br /> � � � � ., �, � ' U� <br /> LEGAL for new conslruction: Shod PlaVsubdivislon Lol No._ (attach copy ol long legal descriplion) <br /> OWNER 5 — — j — PhonelE-mail �— "—_ — <br /> Address "Z'�.V' � j> _ � 1Z00 City/Stale/Zip j� i_ = j <br /> CONTRACTOR i — L&I Lic.# Tll - �._IJ -�= G�— � <br /> Address (L.1,ll h�w� �^"'L ,-- -ti « 7 c4--- �. -�� PhonelEmail ZQ(� - s(J - � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ( � ��\ <br /> ��i�� F�I�I.�k CU��ORA�� -•�=,-i- (���i=c:"�� CALLI x�N J <br /> �honelE-mail �,_ r uZ>S� � � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1 �n K <br /> Existing Use of Building �3 �! o�.D�7!'��= D�'�"GC � HEAT SOURCE: <br /> Proposed Use of Building 3 �nQ.PoR..�Y O�(-�c.�%� Gos_ Elearic_ otner_ <br /> Buildingtype: _SingleFamily _Dupiex_Townhouse _Multi•Family �Commercial <br /> Type of project: _New _Addition �Remodel _Repair_T.I._Sign_Sprinkier_Demolition_Change of Use <br /> Descriplion of Work(adtlitional space provided on the back): . <br /> y.SUO S. t=. 'iJ4lJT �MPROJ=MG�JT 0�= �x� S'�n�el I�:�`� 3IkrJ�c Snlic•�= . 1J=� � <br /> tA.cz,-��on�sCr�oti� szRoc-U¢P•�� A•.�O ��"��s�'"r5 Tt-t20o [�No�� <br /> Have you slarted working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of ProJecl: _Naw_Addn _Altoration_Ropalr Typo ol Pro�ect• _Now_Addn _Alterallon_Ropalr <br /> Show Number(p)ol lixturos SAow Number(0)of�xtums <br /> AIC-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavalory pvash basin) <br /> Water healer I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dish�vasher <br /> Clothes dryer Clothes wa-her <br /> Range hood Water heater <br /> Eahaust fan Sink(service/bar/mop/elc.) <br /> Heat um Backflow prevenler <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodslove Grease lra <br /> Ducting Roof drains <br /> Olher Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> � NumberofHeads I Other: <br /> I hereby cehify thal I havo read and ezamined Ihis applicallon and know Iha same lo be Wo and cortecl.All provisions of lavrs and adinances Boveming <br /> this type of work will 6e wmplied vnlh whether specified herein or not.Tho granting of a permil does nol presumo to give aulhority lo violata or wncel <br /> Il;e provislon ol any olher stale of Iocal law regulaling consitucllon or ihe pertormance of conslruction.Thal 1 am authonzed 6y the owner oi Ihis property <br /> to pertorm the work lor which applicalion Is made and I comply with the Slate Contraclors law 18.27 RCW and 29G200 WAC <br /> ; ` S� N '� - I- 11 ( <br /> `-OW'n i A thoddad ABQnt 5igna ro Date (Revisetl7/2011) � <br /> /'� <br />