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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBINGISIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 - www.everetttw`a.org <br />nnc Aev ArrvorFn FRnM R AM TO 4 PM 7 —010 Z <br />rvru�.ni w.0 �•-^"-" <br />_ p <br />PERMR # <br />SITE ADDRESS: <br />f l <br />PROPERiYT <br />z4sos ItOu 4015 <br />a-o3 <br />0-L v c {� <br />LEGAL for new construction: Short PlaVsubdivi((siion Lot No._ (attach copy of long legal description) <br />SACIU15K Ccolz—'- Prti c-'{te`Z' <br />PhonelE-mail <br />OWNER <br />Address 1KIW ��-s- rc;lr.-o..... S l� 5�b <br />CitylStatefZip �tJit..C_ `.r' • ���� <br />�i"IGG'fiCQSsL Pl.>..�Sr>.t. as (.A'IL�CIa 'Jc.# Ickes L/-..O`[i 21-'- <br />CONTRACTOR <br />Address rz,4-t`- S1 ,v(t_IA:+w� �.� PhonelEmall qz5- j�Z-7 [zEZ <br />.rtC` <br />(';1�� r <br />TENANT BUSINESS N/AtME CONTACT FOR PERMITD:5�� <br />Phone/E-mail 4Zi tZ'1 Tr( .-t- <br />BUILDINGPERMIT APPLICATION <br />CONTRACT PRICE OF WORK 02W <br />HEAT SOURCE: <br />Existing Use of Building <br />Gas_ Electric_ Other_ <br />Proposed Use of Building <br />Single Family _ Duplex __Townhouse _ Multi -Family ;&y -Commercial <br />Building type: _ <br />_ <br />Type of project _New _Addition _Remodel _Repair. T.1._Sign_Sprinkler_Demolition_Change of Use <br />Description of Work (addRionalspace provided on the back) : <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn --Alteration _Repair <br />Type of Project _New_Addn _.Alteration __Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />I AIC - air handling units <br />I Toilet <br />I Forced air systems <br />I Bathtub <br />I Lavatory (wash basin) <br />Gas piping <br />I Shower <br />I Water heater <br />Kitchen sink & disposal <br />I Gas freplace <br />I Dishwasher <br />Gas range <br />I Clothes washer <br />I Clothes dryer <br />Range hood <br />i Water healer <br />I Exhaust fan <br />Sink service/bar/moP/etc.) <br />I Heat pump <br />I Backflow preventer <br />I Unit heater <br />I Urinal <br />I Boiler <br />I Drinking Fountain <br />i Refrigeration <br />1 Floor drain <br />t Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />( Medical Gas <br />-SPRINKLER/ SUPPRESSION SYSTEM <br />I other. <br />Number of Heads <br />I Other: <br />I hereby certify that I have read and examined this application and know the same to be true and cared. All previsions 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 slate or local law regWaling construction or the performance of construction. That I am authorized by the owner of this Property <br />to perform the work for which applintion Is made and I comply with the Slate Contractors Law 16.27 RCW and 296.200 WAC <br />(Revised 2n011) <br />ownerlAuthorized Agent Signature <br />Cale <br />