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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 rrATrnuLt ARF Ar rFOTFn FROM R AM TO 4 PM 3 `� aZ% —rL <br />SITE AOORESS: . _ _ .._--_ <br />PROPERTY TAX 4 <br />PERMIT 0 -OU� <br />.. rc W A <br />J <br />LEGAL for m�v construction: Short Plat/subdivlaion Lot No._ (attach copy of long legal description) <br />OWNER — <br />Phone/E-mail p< <br />Address- <br />City/State/Zip <br />CONTRACTOR <br />L & I Lic. k <br />Hass C-- ; -, �u• t O .cam Phone/Email • . `�;( l <br />TENANT BU INESS NAM <br />CONTACT FOR PERMIT <br />Phone/E-mail tJa • 4�.� <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />HEAT SOURCE: <br />Proposed Use of Building _ Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family 7y— Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.I. ,� Sign _Demolition_ Change of Use <br />,_Sprinkler <br />Description of Work (additional space provided on the back): j y\ 5E4 �� ' - St4 1 l U M 1 t�+a ltrr9. � -� b <br />Have you started working without a permit? _YES _XNO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Type of Project: _flew _Addn _Aheradon _Repalr <br />Slaw Number y fixtures <br />Shaw Number of fixtures <br />A/C - airof <br />handlin units <br />Toilet <br />Forced airs stems <br />t Bathtub <br />Gas piping <br />Lavato wash bvsin <br />I Water heater <br />Shower <br />Kitchen sink & disposal. <br />Gas fireplace <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />I Exhaust fan <br />Sink service/barlmo letc. <br />I Heat pumpBadcflow <br />reventer <br />Unit heater <br />Urinal <br />Boiler <br />I Drinking Fountain <br />Refrigeration <br />Floor drain <br />I Woodstove <br />Grease trap <br />I Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER/ SUPPRESSION SYSTEM <br />other. <br />Number of Heads <br />I Other <br />I hereby certify that I have read and examined this application and know the same to be hue and coned. AN provisions of laws and ordinances govemkng <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 Mate or local law regulating construction or the performance of construction. That I am authorized by the owner of this properly <br />to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200 WAC <br />er lhorized Agent Signature Date (Rewsed 2/20111\/` <br />li <br />