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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.everettwa.org <br />Aoor rCAT!ONq ARF ACCFPTFD FROM 8 AM TO 4 PM <br />.... _._...._.._...._4_ <br />SITE ADDRESS: <br />i4va c e6rrrl�w <br />PROPERTY TAX # <br />PERMIT # <br />��t� -ot� <br />LEGAL for new construction: Plat/subdivision Lot No._// (attachcopy of long legal description) <br />GShort <br />OWNER C:�/►Y'/L /�I�f <br />Phone/E-mail % 04 <br />�I <br />Address �j (Oe%� <br />/`J��1 , ,/ <br />City/State/Zip �/{jr �ry r( �� <br />CONTRACTOR �� <br />I <br />L & I Lic. # %` .I -iz �r naa iz <br />Address I C Y/ rJ'C. — cucCl Phone/Email /%%/Q/�. �/'�%Q%'L�e �I�✓/ <br />TENANT BUSINESS NAME Ul�CONTACT FOR PERMIT fyf�y'1/11O Uj(,OJ�. <br />&41/%( 61 QT LI Phone/E-mail <br />BUILDING PERMIY APPLICATION <br />CONTRACT PRICE OF WORK ola0 <br />Existing Use of Building C HEAT SOURCE: <br />Proposed Use of Buildingr�lL Ges_ Electric _. Other_ <br />Building type: _ Single Family _ Duplex Townhouse M�milFaCommercial <br />Type of project: _ New _ Addition _ Remodel _ Repair T.I. ign _Sprinkler —Demolition—Change of Use <br />Description of Work (additional space provided on the back): <br />1nLL�tl� R7" <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project: _Now_Addn _Altoratlon_Ropair <br />Show Number (0) of fixtures <br />Typo of Project: _New__.Alteration Alteration_ Repair <br />Show Number (#) of fixtures <br />A/C —air handling units <br />Toilet _ <br />Forced air systems <br />I <br />Bathtub <br />Gas piping <br />_ <br />Lavatory (wash basin) <br />Water healer <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />�- <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />_ <br />Heal pump <br />Backfluw preventer <br />_ <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodsl:ve <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRES:iiON SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby certify that 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 compiled 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 state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perfo thew r which application is made and I comply with the State Contractors Law 18.27 ROW and 296.200 WAC <br />OWnerlAuthofized Age t Signabda Date (Revised 212011) <br />