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( � <br /> PERMIT APPLICATlON <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.evefettwa.or,g <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM "'�� I � <br /> SITE ADURESS: PROPERTY TAX p PE,RI�AIT� _�� <br /> $.� � E�^ O O.�Ot O X <br /> LEGAL for new construction: Short PlaUsubtlivision Lol No._ (attach copy of long legal descriplion) <br /> OWNER /�J�C,K 2[K q PhonelE-mail �1p/ �� O <br /> �71�' E'.�zrnuN"7' CilylS�alel2ip �� / f'V <br /> Addruca <br /> CONTRACTOR �;� � i u'laK� L&I Lic.# N� SL-G <br /> Address a, q �3"'P � �..9 0�� Phone/Email a� - 8a2 <br /> TENANT BUSINESS NAME CONTAC7 FOR PERMIT <br /> N '(� �t� �J• PhonelE•mail � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � <br /> Existing l;,e uf Buifding HEAT SOURCE: <br /> Proposed Use ot Building���,.,��ai+�'r_ 3as_ eieclric_ other_ <br /> euilding type: _Single Family _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(additional space provided on the back): <br /> ��,t.�,� pl��•�b�� �Eras P;pp"(� <br /> Have you started working without a permitT _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIOId <br /> Type of ProJect: _New_Addn Alteration�Repalr 7ype of Projoal: _New_Addn _Alteratlon_Rapair <br /> Show Num6er(#10l Pxtures Show Number(M)o/Rxtures <br /> A/C—airhandlingunits I Toilet <br /> Forced air systems Bathtub <br /> �Gas piping Lavalory(wash basin) <br /> Water heater Shower <br /> Gas fireplace � Kitchen sink&dispusal <br /> Gas range Dishwasher <br /> Clolhes dryer Clothes washer <br /> Range hood Water heater <br /> Exhausl fan � Sink(service/bar/mop/etc.) h 3 LGL,. • <br /> Heal pump Backtlow preventer - <br /> Jnit heater Urinal <br /> Boiler Grinking Fountain <br /> Re(rigeretion Floor diain <br /> Woodslove � Grease lrap <br /> Ducting Roof drains <br /> Other Mediral Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other. <br /> Number of Heads Other: <br /> I hereby ceAify that I have read and ezamined ihis applicatlon and know Ihe same to bo lruo and conect.All provisfans of laws and ordinances goveming <br /> lhis lype of work will be complied wilh whelher specified herein or nol.Tha granling of a permil does not presume lo give authority lo violate or cancel <br /> the provision of any other st r I w regulating conslruction or Ihe performance of conslrucllon.That I am authorized by the owner of lhis propeAy <br /> to perto e k f c s mado and I comply wilPi Ihe Slate Contractors Law 18.27 RCW and 296.20U WAC <br /> O /d / <br /> Otvne utho ze igna ure Date (Revised22011; <br />