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; PERMIT APPLICATION <br /> BUI�DING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-6857—�wvw.everett�va.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: J pRopERn rti(p <br /> ��� LG�. C'���."rJC 'JrGG , - PERMIZ <br /> _ 2�'� <br /> LEGAL for new construction: ShoR PkV.ubdivlsion Lot No. � <br /> _ (2ttach copy of long legal descdption) <br /> OWNER ; Phone/E-mail .��(�f'�7�3����7 <br /> Addre,s /�,� .m l�. City/StalelZip �/�"'�Tr � <br /> CONTRF,CTOR ` pL/�9l3 .-�. L&I Lla r ' '„j. J' G C ( � ! <br /> Address . G �3, � � (� �/N/� C U3 Fhone/Email ZS-�S-�G(l(c' . <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ^ <br /> hr�.Qjl/' v��'cf/�� <br /> PnanelE-mzii I� ��- 77,5(p L <br /> BUILDING PERMIT APPLICATION CONiRACT PRICE OF WORK_7� >i/C'�.C�C� <br /> Exislina Use of Building HEA'SOURCE: <br /> Pr000sed Use of Building Gas � Electric O;her_ <br /> Buiidingtype: �SingleFamily __Duplex_Totvnhouse _Multi-Family _Commercial <br /> Typeotproject: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkier_Damotition_Change ofU_=e <br /> DeSCriplionoFWofk(eddifionalspaceprovldedonfhebackJ: �E�L�_� /� � <br /> ��CIST�YV� CTi4� /�I�N��f� �,'f.�/n�� <br /> n,'E«' C.�15 Ic�i�'it,%, ��- T� .5qr1r� LC ' ) <br /> -c:a�r-tZ�,-�, �� ,�c��,' C-��s d rl�i,���- . <br /> Have you starterl a�odcing without a permit7 _YES �NO � <br /> MECHANICAL PERMIT APPLICATION PLUI:761NG PERh11T APPLICAT1017 <br /> TSPeotProJcct _Nevi_Addn � Iteration_Repair TypeofProJecL _New_Addn Alteralion_Repair <br /> Shovi Num6er('„)of�ixtums Show Number(�)of Iixtures <br /> � FVC-airhandlingunits � Toiiet <br /> � Forced air syslems � Bathtub <br /> � Gas piping <br /> Water hezter � Lavatory(wash basin) <br /> � Gas fireplace � Shaver <br /> � Kitchen slnk 8 disposal <br /> � Gas range � Dishwasher <br />� � I Clothzs dryer <br /> I Clolhes�vzsher <br /> � Ranqe hood � W2ter heater <br /> � Exhzust fan � Sink(servicePoarimop/elc.) <br /> � He�t pump � Backflow preventer <br /> � Unit heatzr Urinzl <br /> I B�iler I Drinking Fountain <br /> � Reirigeretion I Floor drain <br /> � Woodstove � Grease tr2p <br /> � Ducting I Roof drzins <br /> � Other I Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I Other. <br /> � NumheraiHe2ds � Other: <br /> I here6y certiy thzt I hzve rezd�nd e�mined this appli�tion end knori the same to be true 2rd correct All provisions of la��s and ordin2nces governing <br /> this type ot vrork v.ill he compiied vrith whether epecif;ed herein or not 7he granGng of a pertnit does not presume to give suthoriry lo violate or c�nce! <br /> lhe provislon of ary o:her etate or loal law regWating cnnsVuction or the performznce of consWcfion.That I am euNorizzd 6y ihe o�mer of this property <br /> � ��G°�arm�the vrork for which 2p �' ti Is m2de�nd I comply with ne S,zt Contr2ctors Lsw 18.27 RCW 2ad 2?fi200 WAC <br /> ��" y� � <br /> i_ G /z� Z <br /> OwnerlA orizcdAgentS nat c Date (Reviscd2/2011) <br />