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, r <br /> � <br /> � <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—ww�nr.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � '�. � I A a PROPENTY7AXp P MI <br /> �� . lt l� �� o -L�'" z�?�� � 1 toa - o� <br /> LEGAL lor new construUion: Shotl PlatlsubAivision__ Lot No. <br /> _ (attach copy of Ionq legal tlesulption) <br /> OWNER �� ._ � � ` / <br /> !��'�t" 6� �(� Phone�Emall l� '. ��- ' �,�, � <br /> naa�ess n >It fl i � ' � � � <br /> CkylS�ale2ip ��� y C,j`r� • <br /> CONTRACrOR ! �� � �� � i L&I Lic.# �i� �?�(�' n,"^-� <br /> ��[� / <br /> Address '!,� � .. : �. +�' C flr'.fJ <br /> l� /D Phone/Email � :� �t:��y��k.l. �l�s✓/ <br /> TENANT BUSINE S NAME CONTACT FOR PERMIT y <br /> l .� � I ')1 ��%��/! - <br /> /�� L/���/ Phone/E-mail �� <��` "'/ '��� <br /> �� o r � .•Z � CC - C[M� <br /> BUILDING PERMIT APPLICATION CONTRACT PR�CE OF WORK <br /> --v �-�� <br /> Existing Use of Building � � L' <br /> �� HEATSOURCE: <br /> Proposed Use of Building ; :1�'t�/�j J <br /> Ga Ekanc Olher <br /> Buildingtype: _SingleFamily _Duplex_Townhouse Multi-family �Commercial <br /> Type of project: _New _qddltion _Remodel Repair�T.l._Sign_Sprinkler_Oemolition Changa of Use <br /> DeScnptionOfWork adtlifionalspacepmvidedontho6ock : — <br /> l,Y�l/>,�=�� �'���n;�/ � (/> 13'r2=�ffr� <br /> Have you started worktn�wilhout a permit? _YES �NO <br /> MECHANICAL PERMIT APpLICATION PLUMBIMG PERMIT APPLICATION <br /> TypoofProject: _New,_Addn _Altaration_Repair TypeofproJect: _New_qddn _Alteration_Ropair <br /> Show Numbcr(p)o/fixtures Show Numbor(p)01�xfures <br /> NC-air handlin�unils Toilet <br /> Forced air systems Bathtub <br /> Gas pipin — <br /> Water heater Lavatory pvash basin) <br /> Gas fireplace Shower <br /> Gas range Kitchen sink 8 disposal <br /> _ C�olhes dryer Dishwasher <br /> Ran e hood Clolhes washer <br /> Exhaustfan Wafer heater <br /> _ Heat pump Sink(servicePoar/moplelc.) <br /> Backllow preventer <br /> Unit healer Unnal <br /> Boiler <br /> Refri eration — <br /> Drinking Fountain <br /> Woodstove Floor drein <br /> Ductin Grease trap <br /> Other �oo(drains <br /> SPRINKLER/ SUPPRESSION SYSTEM — Medica�Gas <br /> Other <br /> -- _ Number ol Hcads <br /> I hereby cedity thal I have reaa anU exemined this appliwlion and know lho samo to ba Irue aM wrreq.qll piovisions ol lavrs and ortlinances goveming <br /> Ihis lype ot woik will Le complied wilh whether speGfred herein or nol.7he granting ol a pmmil does not presume to give authoiily to violaH ^r cancet <br /> tho provisi any oU�er slate or Iocal law regula�ing wnslruetion or Ihe perfomiance o1 conslmclion.That I am aulhonzetl ey Vie axner o�this piopetly <br /> lo pedo� i C3�r which a licalion is matle and I comply wiUi lhe Stale Contrar.tors Law 1027 RC1'J and 20G200 WAC <br /> � <br /> , - , --; (�, _ J/ <br /> Owi er/Authorizetl Agent SlgnaWrc Da;e <br /> (Revised 11/10f0) <br /> � � <br />