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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 -�I Z'� <br /> SITEADDRESS: PNOPERNiAXp P RMITN <br /> 31 c,�o+��n �r- -oZs <br /> LEGAL for new conslruction� Short PIaVs��'.Jivision Lol No._ (attach wpy ol long legal descnption) <br /> OWNER C�l"'1� J l'�V�c,f U /�h �S. PhonGE�mail <br /> Atldmss CitylStatelZip <br /> APPLICANT:_Owner OvmefsAgent �Contraclor Contractor'sAgent T003f11(mu�tproriEe�ktlero/mmonifromT�wrtialaCo¢vAintln�Pea) <br /> CONTRACTOR CS r'�C✓ �U�7I /UJ'�`�*'l L&I Lic.i� � J� J�7 — �� coe eu..uc.n C�NO 'A�T7JI'�Z <br /> Address �? I (�� �7�r4 S ,• S=�:[I' �4 � r U�S� PhonelEmail ��— ��J -5 La0 <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> P�onelE-mall �YC��Z "' ✓�w� Y'�^�"��j • � ��� <br /> BUILDING PERMIT APPILICATION CONTRacTPRICEOFwoRK y SOU• �-- <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of$ui�ding Gas_ Eiectric_ Other <br /> Buildingtype: ��SingleFamily _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of pro'ect: _New Addition Remodel Repair T.I. Si n Sprinkler_Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additiona�space providen on the back): //�� f �n 5`��I P �� I,t�O e t� <br /> C 3 �(�.lY�✓ l)-{ ���q�!/1� <br /> 'T`a..r� J �1 ! �� 1 /� <br /> c�hc.! �.rs'f�. �� 17�tw Cc�c�+f'��r'1 ,��� S�l�tfL�-S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofProJect: _New_Addn _Alleralion_Repair TypootProJecl: _New_Addn _Alteratlon_Repalr <br /> Show Number(#1 of Oxtures Show Number(Nl of flrtures <br /> A/C—air handling units Toilet <br /> Forced air systems 8athtub <br /> Gas pipin Lavalo (wash basin) <br /> Waler heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> �� Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Ran e hood Waler heater <br /> Ezhaust fan S!nk(service/badmop/elc.) <br /> Heal pump Backflow prevenler <br /> Unil healer Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease lrep <br /> IDucdn Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> ; Number of Heads Olher: <br /> I�ereEy cenily Ihal l havomad en0 eaominetl lnis aCPlka�ion end knmv I�o same to bo truo ond cortect.All pmvisions ol Wx�nnd oNinances goveming l�le ypa olvro�k�No bo comp0etl <br /> wdh ut�e1�M sDedf�etl�erein of not.T�e 9raniing oi a pertnit doef not D�sumo l0 0Ho euNony to Nolate o�wncel lho provision ol nny ot�er slato or local hw repulatmq consinidion <br /> T�ot I am aWhonxetl�I�o ownerolNb p ertorm No work forwhk�opp9catbn b maCe and I wmpywa�t�e S�ota Conlmcton Lsv 1027 RCW nnd 290.2�OA WAC. <br /> �l <br /> �. � ��z_ 3/�z/� <br /> Owner/Authorized Agent SlgnaWre Dato (Revised 6/2012J <br /> � <br />