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• PERMIT ApPLICATlO�� <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITIOIJ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 vuww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM I'Z,..o7�/•-I <br /> SITE ADDRESS: %�/�� DA �/�-� I- '�/ PROPEN�Sp 2�OO�O/�Z5 ' P R T /'� <br /> f_��r ry v�./ �r�7 �'��V� <br /> LEGAL for newconslruc6on: Short PlaUsubtlivision iEE �Gh'G� Lot No._ (atlach copy of long legal description) <br /> OWNER �NDA L�w(s Phone/E•mail yiS -Z90-syyo <br /> ndaress 10�zs D A�A Wy CitylStatelZip E1//�jT (.✓R_ 1��y <br /> APPLICANT: _Ovmer _ OwnefsAgent �c:onlracWr Contractor'sAgenl _Tenanllm�s�om.�ecaicr,e�oiw�xmo-ommao...,e�iom.wn�,masoacai <br /> CONTRACTOR NDAN� �il./r..luo L 8 I Lic.# �N�A6$n�o�`� COE �us. Lic.tl D3Lo52. <br /> nddress �011g /��)N �f'' Tb! t�11�. �j'�O/� phonelEmail ��-7bl—/IOI�/ <br /> TENANT BUSINESS NAME CUNTACT FOR PERMIT 5'NN�A�If�Q,�/� ��t/ <br /> Phonc/E-mail <br /> BUILDING PERMIT APPLICAYION CONTRACT PRICE OF WORK <br /> Exisling Use of Building A HEAT SOURCE: <br /> Proposec'Use af Building t7��`'� Gas_ Eleclnc�Olher <br /> Building type: D�Single Famiry _Dupicr._To�mhouse _Multi-Family _Commercial <br /> T pe of pro-ecC __New Addilion Remodel Repair_T. _Sign. __Sprinkler_�emolilion Chan a of Use <br /> DESCRIPTION OF WORK(a�eirionalspace p.ovided on�ne back): A <br /> /n/JTA iU�✓� A �vE.w Q uGT'Crc.Ss td�T!'i�M� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type oi Project: _New_Addn �Alteration_Repair Type ot Project: _New_Addn _Alleration_R¢pa(r <br /> Show Numbcr(fl�o/fixtures Show Number(p)ol firfures <br /> A/C-au handling unils Toilet <br /> Forced air s slems Bathtu6 <br /> Gas pipin Lavalo (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kdchen sink 8 dist>osat <br /> Gas range Dishwasher <br /> Clothes d er Clolhes washer <br /> Ranqe hood Waler heater <br /> Exhausl fan Sink servicelbadmop/etc. <br /> Heal pump Backflow prevenler <br /> Unit healer Urinal <br /> Boiler Drinkin Fountain <br /> Re(riqera6on Floor drain <br /> Woodstovc Grease irap <br /> Ductin Roof drains <br /> Olher Medicai Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Numhcr of Heads Other. <br /> I hereby«mfy Ihal I havr read and e.amineA;hls appl�cuwn and Mnmv the same to be we and conect.AA pmvrsbns ol Nv,and ordinances 9oveming Ihis rype ol v.vrk wi116e mmplied <br /> wth whc0ier spcuGM here�n or not Thc granung ol a permit tloe•,nol pmsume to givc aulAomy to voutc or cancel lhe pmvision ol any o0�cr sLitc or bcal Liw reguUw9 mnstruclan <br /> 7hat I am authOnted hy U+ m+�ier ol ihn pmpeny to pedorm the wark lor which appleation¢made anC I compNvnlh ihe S�ato ConuaUors Law 1827 RCW anJ 29G.2DOA wAC. <br /> / `�z <br /> �'h /L-23,f 3 <br /> OwncdAuthorl A Age ignature Date (Rr,vised Cu2012) <br /> rW <br />