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� � { <br /> PERMIT APPLICATION <br /> BUILQING/MECHANICAL/PLUMBlNG/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810 -FAX 425-257-8857 -www.everettwa.org <br /> APPLICAT�ONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRE53: 1OU� � EVERGREEI`J yl//.��� PROPEHiVTAXM PER T <br /> LEGAL br new construction: Shotl PlaUsuMlivision S�+L'11 Poll.tr MALL Lol No._ I�Itach copy ol long legal descriplion) <br /> OWNER �RE� �LpSE— <br /> c SSE So S PMneIE•mail ��25 990- 62op eK�. I� <br /> nddress (oD0 jo8� f}VE. N•E. Su�TE 53o CitylSlatalZip gELLEVUE WA �800'�' <br /> CONTRACTOR F}OBB`l �BB`1 L&I Lic.# C C01 t-toBB`I L S901 DT EXP. 3-2 - I Z <br /> -1-7 0'7 S.W. �4-� STIZEEI- ptwne/Email (�Fos) ��{5- br o <br /> Address OKIA. G 9 <br /> TENAN78USINESSNAME CONTACTFORPERMITDtRK �RoeKETr �fo5-7�{5-161a <br /> F}o�6`I �-o�`l Phone/E-mail dirk.croc.keEt �ob� �o�� . con� <br /> BUILDIN6 PERMIT APPLICATION CONTRACT PRICE OF WORK� -7 25f o00 � <br /> ExistingUseofBuilding M�R�NT�LE HEATSOURCE: <br /> Proposed Use of Building M E R���� Gas Eleclnc_ Olher__ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of projecl: _New _Addition _Rcma�el� _Repair T.I._Sign_Sprinkler_Demolilion_Change ot Use <br /> DeStrip�ionofWork(addilionalspaceprovidedonfheback): SS��}O$ Sq.FT. �l�Ahl'r UP FI'r, h1EW RFSTRoo�Y15� <br /> LourlGE� sTac.K� � oF�kES_ NEW PAiNT � FIhi15NE5 TYPICA� oF +1aRf3'1 lpQ�4 �TaR�. <br /> µEW Ll6F{-r-5. <br /> Hava you started working without a permit7 _YES X NO <br /> MECFIANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of ProJect: _New_Addn _Alteratlon_Repair Typs of ProJect: _New_Addn _Allara[ion_Repair <br /> Show Number(N)0/flirturea Show NumWr K o/fl�rtures <br /> � A/C-airhandlin units i _ Toilet <br /> I Forced air s slems i Bathtub <br /> � Gas i in Lavato wash basin <br /> Waterheater I Shower <br /> � Gas fireplace I Kilchen sink&dis al <br /> � Gas ran e i Uishwa,her <br /> I Clo�hes d er i Clothes washer <br /> � Ran e hood I Waler heater <br /> i Exhaust fan i Sink(sr,nicelbar/mo letc. <br /> � Heal pump BackOav preventer <br /> I Unit heater i Urin2! <br /> i Boiler I Drinkina Fountain <br /> i Refri eration i ;'iuor drain <br /> i Woodstove i Grease tra <br /> � Ductinc+ � Roof drains <br /> � Olher I Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM i other: <br /> � NumberofHeads I Other: <br /> I hereby ceAify thal I have read and examined Ihis application and know Ihe same to be Irue and cortec�.All provisions of laws and ortlinances goveming <br /> ihis type of work vnll be complied with whelher specified herein or not.The granting of a permit does not presume lo give aulhorily lo violala or cancel <br /> !ho provision of any other slate or Iocal law regulaling consiruclion ar Ihe peAormanca ol construclion.Thal I am aulhorizad by Ihe owner of Ihis property <br /> to pedorm Ihe�+vrk for which applicalion is made and I comply vnlh Ihe State CoMractors Law 1827 RCW a�d 298.200 WAC �j <br /> �a=—�`�� � (�� 2 �. J� � <br /> OwnadAuthodzed Agent Signature Dale (RevisedY20f 1J <br />