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PERMIT APPLICATION ' <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES ���p --II <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS: PROPERTY TAX N PERMIT A <br /> G R� S��1Jr �P�c Cv �s S D S �00 0 l.9 " o�-fo <br /> LEGAL 1or new conslruction: Short Plal/su6division Lot No._ (atlach copy ol long legat descriplion) <br /> OWNER /}� �i' Uy' I�yvr S PhonelE-mail �� '7 Zur- �1(��" �� c� <br /> Address ��j 0 Ci Cf-v)CiG'V( r i V C CitylSlate/Zip � " � B �i�3 <br /> CONTRACTOR S Z UI LG�-S L&I Lic.# <br /> AtlCress PhonelEmail . �Q�� � �� <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> i r !/�P��C]��� _ /� <br /> PhonelE-mail �^-4 ' --- ^�- � <br /> BUILDING PERMIT APPLICATION coNTRAC7 P iC oF WORK �Od 0 ,° <br /> Existing Use of Building S� ,��5(�/l� C.c� HEAT SOURCE: <br /> Proposed Use ol Bu�ilding .�7� �V'���(..� Gas__ Electnc_ Olher_ <br /> Building type: (/Single Family _Duplex�Townhouse _Multi-Famiiy _Commercial <br /> Typeofproject: _New _Addition �Remodel _Repair_T.I.,_Sign_Sprinkler_Demolilion_Chanoe o�Use <br /> Descripti0n of Work(addRiona�space pmvidetl on tne 6ack): <br /> �lG- l2�IvIbD� � «��olz� bc�av✓ <br /> Have you staAed working without a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Pro�oet: _New_Addn _Alteratlon_Ropalr Typo of ProJoct: _Now_Addn _Alteralion_Ropair <br /> Show Numbcr(N)of lislures Show Number(p/ol lixtures <br /> A/C-air handlmg units Toilel <br /> Forced air s stems Bathtub <br /> Gas piping Lavalory(wash basin) <br /> Water heater I Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clolhes dryer Clolhes washer <br /> Range hood Water heater <br /> Exhausl fan Sink(service/barlmopletc.) <br /> Heat pump Backtlow preventer <br /> Unit healer Urinai <br /> Boiler Drinking Fountain <br /> Refri eralion Floor tlrain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> NumberoiHeads Other: <br /> I hereby cerlifq Ihat I have read and examined Ihis applicalion and know tho same lo be Irue and correcl.All provisions of Iaws antl vrdinances Boverning <br /> Ihis�ype ol work will be camplied wilh whelher specifed herein or nol.The granting ol a permit does not presume Io give authorily to violate or cancet <br /> the pwvision ol any other slate or local law regulating consiruclion or Ihe peAormance al constmclioa Thal I am aulharized by Ihe owner of Ihis properly <br /> lo e�orm 11 e rk lor which appliw( �•ma e and 1 compiy wilh Ihe Stale Coniraclors Law 1827 RCW and 296100 WAC �/� <br /> � � '/S� �U�� <br /> � <br /> Owner Aulho Izad Agont Slgnaluro Dale (Revised?/2011) <br />