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N <br />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 ARF ACCEPTED FROM 8 AM TO 4 PM / it, —3 — V <br />SITE ADDRESS: - 1.L.- <br />�ro� et %�_ <br />PROKRTY TAX N <br />PERMIT # <br />-Cry <br />LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br />OWNERC'Z(1t�� -=gyp►-tL-� �.��•,.�,� <br />PhonelE-mail �S �1- (CC4 <br />r1 <br />Address �.0 +—'K�AvT "�^'^"� <br />City/State/Zip e-4i:CL—P-7� yja-. Abz;4 <br />CONTRACTOR t r t f -► 'vim <br />L& I Lic. # AAA e2i14 � L�OZ- O L <br />Address 6LIoy ­:5v �,dr�...�(AI? 'r PhonelEmail (wLZ-7L b <br />TENANT BUSINESS NAIl {T� <br />1'c LY�.I Tt l a V7, , �L� <br />CONTACT FOR PERMIT <br />Phone/E-mail Z';10 <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK l l <br />Existing Use of BuildingHEAT SOURCE: <br />Proposed Use of Building I at`�-c`�^"t i `T'''� ­5�GS Gas_ Electric_ Other_ <br />Building type: _Single Family _ Duplex _Townhouse _Multi -Family Commercial <br />Type of project: _ New _ Addition — Remodel _ Repair —T.I. -�„ Sign _Sprinkier _Demolition_Change of Use <br />Description of Work (additional space provided on the back): _ � <br />1�1e'�-� wf CI kj u S I�� 1 rr-�1,11 t <<k[kw (a1 <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 />Show Number (#) of fixtures <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number(#) of fixtures <br />A/C - airhandlin units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatory wash basin <br />Water heater <br />Shower <br />Gas fire lace <br />Kitchen sink & disposal <br />Gas ran a <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink servicelbarlmo /etc. <br />Heat pump <br />BackBow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />ReIL eration <br />Woodslove <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 complied with whether specified herein of 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 I regulating construction or the performance of construction. That I am authorized by the owner of this property <br />1 the work for whica o made and I comply with the State Contractors Law 18.27 RCW and 296.200 W'AC <br />IOf3 III <br />Owner/AuthoorIz-e 7rgffnt Signature (' norDa e� j� (Revised Z2011) <br />t--11 t>(,i <br />I/oc <br />