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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 />Baal Ir.ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I / — / 7 " <br />SITE ADDRESS: � A <br />WR <br />PROPz ERTY TAX <br />S�z0100 1 <br />P <br />IT <br />ro <br />*L1. <br />LEGAL for new construction: Short PlaVsubdivislon Lot No._ (attach copy of long legal description) <br />OWNER 41r �( <br />E-mail AJ(E �LGYt1 N4 <br />Address 67i?i� �1p�111A <br />�wr .J..v WAJ <br />Cily/State/Zip W WC— <br />tt.. <br />CONTRACTOR rt71Zs IA W � �� , <br />L & I Lic. # 7iU 3 :3 % <br />Address Phone/Email r an P- ter' w i. cool <br />TENANT BUSINESS NAME <br />e46M1 - FWAL, 0 blr-r 6% <br />CONORPERMIT 204, Sol-7TCID <br />Phone/E-mail MICHAGL, P (9 Fi BWO f�.CA •COM <br />BUILDING PERMIT APPLICATION <br />ICONTRACT PRICE OF WORK <br />Existing Use of Building +<ZEi'14I L S'TaYZ� HEAT SOURCE: <br />Proposed Use of Building R �7AIt� �a'(i.321e Gas Electric_ Other_ <br />Building type: _ Single Family _Duplex _Townhouse _ Multi -Family ACommercial <br />Type of project: _ New _Addition _ Remodel _X Repair_T.I. _ Sign _SprinklerlDemolilion_Change of Use <br />Description of Work (additional space provided on the back): <br />Have you started working without a permit? _YES _XNO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typeof Project: _New_Addn _Alteration_Repair <br />Show Number(#)of fixtures <br />Typeof Project: _New_Addn _Alteration_Repair <br />Show Number(#)of fixtures <br />A/C — air handling units <br />Toilet <br />Forced air systems <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 />Dishwasher <br />Clothes dryer <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 I 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 Imo and correct. All provisions 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 state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform the work for which application Is made and I comply with the late Contractors Law 18.27 RCW and 296.200 WAC <br />Ow�uthorized Agent Signature Dale (Revised212011) / <br />(/' <br />