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( . � <br /> PERMIT APPLICATION I <br /> BUILnING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WP 98201 -425-257-8810—FAX 425-257-8857—wuvw.everettwa.org / <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �a-I""4I <br /> SITEADDRESS: PROPER7YTA%If OD LW IOO PER �--- <br /> 0 YGv Y�Ph Wu '7'$���- ' <br /> LEGAL for new conslruction: Short PlaVsubdrvision Lot No._ (atlach copy ol long legal descnption) <br /> OWNER �jDt..'�'6+ DI �' �AZH PhonelE-mail I <br /> Address O�0 C..��1 h D N FLi CitylStatelZip �A G! �7 L W� � p�T 7 <br /> CONTRACTOR ������ Si HS L&ILic.# CLARi51 `�'Z1 �g��-{ <br /> ddress �l2cy f�� (15��' $i' Leh mcrc. Wb q8o2Ss Phoi..�Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT y ZS 48� �b� <br /> Ml`r0.Ll.(, �'�v PhonelE-mail I�ohha �i-�'ce�-+ IK�eclar�l-t, Si l,S . co�.-i <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �0 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Eiectnc_ Otner_ <br /> Buildinglype: _SingleFamily _Duplex_Townhouse _Mulli-Family _Commercial <br /> Type of projecl: _New _Addition _Remodei _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DeSCrip�ian ot Work(addilional s ce provitled on/f'h�e 6ackL): )� -�7,--�I � <br /> � � S��l � � � �el D(- � 1" `I'hAI�1.1 � 1 � GV7Lll� Nfl � l (�YS <br /> 1 <br /> Have you sWrted working without a permit7 _YES y NO <br /> MECNANICAL PERMlT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of ProJect: _New_Addn _Alteration_Repair <br /> Show Number(a)ol�xtures Show Number(p10l�xt�res <br /> A/C-airhandlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas pi in Lavato (wash basin) <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhausl fan Sink serncelbarlmo letc. <br /> Heat um Backflow reventer <br /> U.�it heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eralion Floordrain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number of Heads � Other: <br /> I hereby certily ihat I have read and ezaminetl Ihis application and know the same lo be lrua antl correct.All provisions of laws anA orGinances goveming <br /> this tyFe ol work will be complied wilh wfiether specifetl herein or noL The grenting ot a pc:rtnit dces not presume to give aulhonty to violate or wncel <br /> the provision ol any olher stale or lowl law regulating wnswction or the pedormance o1 amstruction.That I em authonud by the ovmer ol this property <br /> to pertorm Ihe work for whicj'��pp�licatio�n is made antl I comply w�th the State Contractors Lav 7827 RCW and 296200 WAC <br /> ��I�.a- 7"�Le�-�-� '1�►FS(►1 <br /> OwnerlAuthorizedAgenl gnaWre Date (Revised22011) <br /> // `� <br />