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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL'PLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-887 0—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE A.CEPTED FROM 8 AM TO 4 PM t��'I ` �I <br /> SITEADDRESS: PROPERTYTA%p P MIT� , ` <br /> 483o GI - �'r E.,e�-et-{; �,uq �7Pzo3 _��-r <br /> LEGAL lor new construction: Shart PlaUsubtlivision Lot No._ (attech copy ot long legel desc�iplion) <br /> OWNER l� u� �k-k>�'� Phone/E-meil 425- 3SU^ �60 Z <br /> Address y�3p Cj�e��wmc� rver'� QgZ�'3 CilylSlalelZip <br /> CONTRACTOR 13c�rc�� f,,��M�'�.rSL.luec�0.N1 LBILic.# a � A C� � �`''r RS� � S <br /> Address Z761I .�� I i 7�.� S� �e"'�j �� `� �o� / phonelEmail ?06- �Z�— Z�'� � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE•mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRlce oF woRK �� -��� ' �� <br /> Existing Use of Building HEAT SOURCE: <br /> Propased Use of Building Gas_ Eiectric_ Other <br /> Building lype: ,_Singie Family _Duplex_Townhouse _Multi•Family _CommerciPl <br /> Type of project: _New _Addilion _Remodel _Repair_T.I._Slgn_Sprinkler_Demolition_Change of Use <br /> Descri tionofWork additionals acaprovidedonfheback): - S f vn-�+' ��"` �-o <br /> P ( P �q -. vev ,-}- �L e� <br /> �n}/7 I,C.'J� O,... � - -�'•� �� �7 a. + l.; , �..,, t� I - ��2 bc�+� � E-^'. � C �h..-.q <br /> �' � v:w � e e c� w r-�-uw I ��.,e �v 160 1'S I P�-X- / <br /> � <br /> Have you sUrted working without a pertnit? _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PEitMIT APPLICwTION <br /> Type of ProJeet: _New_Addn _Altentlon_Repalr Type of ProJeet: _New_Addn _Altewtlon_Rap�ir <br /> Show Num6er(M)o!fixtures Show Number(M)o/!lxtures <br /> A1C-airhandlin units 2 Toiiet <br /> Forcedairs stems I Bathlub <br /> Gas ipin 2 Lavato (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gasran e Dishwasher <br /> Clothes d er 1 Clothes washer <br /> Ran e hood Water heater <br /> Exhausl fan � Sink(service/barlmopletc.) <br /> Heat pump BackFlow reventer <br /> Unit heater Urinat <br /> Boiler Drinkin Fountain <br /> Retri eration Floordrain <br /> Woodstove Grease tra . <br /> Ducting Roof drains <br /> Olher Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM � Other: 1��s� b � b <br /> Number of Heads � Olher. 1.�1 c�'�� -s �`��'� � <br /> 1 hereby certity lhat I have read and ezamined this applicallon and know Ihe same to be truo and cortect.All provisions of laws and ordinances goveming <br /> this lype of work will be complied wilh whether speciGed herein or not.The grenting of a permit does nol presume lo give authority to vioiate or wncel <br /> the provision of any other state or Iocal law regulating constructlon or Ihe peAormance of construction.That I am euthorized by the owner ol this property <br /> to pertorm the work lor which appllcation is made antl I comply with lhe Stato Conlrectors Lew 18.27 RCW end 296.200 WAC <br /> �_�_�'..� � � � I � lS— / l <br /> OwneriAuthorized A�,,,t Slgnature Dale (.4evised?/2011) <br />