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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 mvw.everettwa.org <br />Pc ACCEPTED FROM A AM TO d. PM <br />SITE ADDRESS: <br />PROPERTY TAX# <br />- 003-039-00 <br />PER TM Gl <br />—U Z <br />/ <br />LEGAL for new construction: ShortPlat/subdlvislon Lot No._ (attach copy of long legal descnpt ion) <br />OWNER -f/ L Phone/E-mail 2,0(o) 1 (>- //7 <br />Address 5 S F Sr 5 � City/State/Zip el'C -T/Qry 'A)9SO410 <br />APPLICANT: _Owner _Oviner's Agent ,_Contractor Contractors Agent _Tenant hmlprmeeaktter crcoosemhom mo wmxto dowva rune spas) <br />_ <br />'= L L 8 I Lic. # Vic. I L r (lL- $9 Bus. Lic. I <br />CONTRACTOR C t <br />Address y s s'h Vt' 50V-L� Phone/EmM <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />.Zc(o)aN9-7YS*3 <br />jj <br />Pa N e�4 (l°4(f Phone/E-mail tcCi roc. /, "— <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />HEAT SOURCE: <br />Existing Use of Building <br />Gas_ Electric_ Other_ <br />Proposed Use of Building <br />V <br />Building type: ingle Family _Duplex _Townhouse _Multi -Family Commercial <br />_ <br />Tyoe of pro act: New Addition Remodel Repair_ T.I. _Sign Sprinkler __Demolition_Chan a of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration_Repair <br />Type of Project: _ANew_Addn _Alteration —Repair <br />Show Number (#) of fixtures <br />Show Number (a) of fixtures <br />AIC - air handling units <br />7, i Toilet -_ <br />Forced airs stems <br />Bathtub <br />Gas poplin <br />Lavatory (wash basin) <br />Water heater <br />I <br />Shower <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />I Water heater <br />- <br />Exhaust fan <br />I Sink (service/bar/mop/etc I <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinkinq Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />- <br />Roof drains bye( <br />Other _ <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: IcLr, 5r,,,x <br />Number of Heads <br />I <br />Other: eye w S lh <br />1 hereby bandy Not I have read and examined this application and know 0o same to be true and correct. All provisions of laws rnd ordinances governing this type of work wil be complied <br />With whether specified herein or not. The granting of a permit does nct presume to gho authority to violate or cancel the provision of any other state or local few mgutating construction <br />That I am aulhodred by the Owner of this property to perform the work for whirls application is mode and I empty wth the Slate Contractors Law 1e.27 RCW and 299.2geA WAC. <br />OWnerlAuthorized Agent Signature Dale <br />(Reused 612012) <br />