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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 — www.evehrrettwa.org <br />neoren eonM A AM TO d PM #2 —/D — // <br />APPUCA r KA,5 Aii, <br />P IT# <br />SITE ADDRESS: PROPERTYTAX4 <br />—�pZ <br />LEGAL for new construction: Short Plailsubr ivision Lot No._ (attach copy of long legal description) <br />OWNER <br />Phone/E-mail <br />Address <br />City/Stale/Zip <br />L & I Lic. # <br />0 <br />CONTRACTOR V V r, i r. t. <br />' ! <br />Address a I —Ia.-4— GJ ( PhonelEmail S ^ �- ! l7 <br />TEEl'ESS NAME CONTACT FOR PERMIT <br />.L <br />L /�(itJ IS ANC �C+h �5/ Phone/E-mall ��Z 5 a7 5 S 71 <br />B G P RMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />HEAT SOURCE: <br />Existing Use of Building <br />GasElectric_ Other_ <br />Proposed Use of Building <br />Multi -Family g Commercial <br />Building type: _ Single Family _ Duplex Townhouse _ <br />KRepair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br />Type of project: New _Addition _Remodel <br />,_ <br />Description of Work (additional space provided on the back): <br />AV <br />�', A, !- �11 J „a `� r ,mc� \x- h <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: <br />__Alteration _Repair <br />Type of Project:-_Now_Addn <br />_Alteration 4Reoalr <br />_New_Addn <br />Show <br />Number (#) o/ fixtures <br />Show <br />Number (#) of fixtures <br />Toilet <br />AIC — air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />C <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backtlow preventer <br />Heal pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Ducting <br />Medical Gas <br />Other <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: u,yv�r-C alp / r1 <br />Number of Heads <br />Other. <br />I hereby certify -.hat I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing <br />this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the provision of any other star or local law regulating constmctlon or the performance of construction. That I am authorized by the owner of this property <br />to perform t work for,vhich pplicalion is made and I comply with the Slate Contractors Law 18.27 RCW and 296.200 WAC <br />/l7 /lI / [ <br />40w,4,thorlgan Signature <br />Date (Revised 7J2011) <br />