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( c: <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evereil, WA 98201 -425-257-8810— FAX 425-257-6857—www.evereitwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM ll � a3 •.•`I <br /> PROPERTY TA%N PERMIT <br /> I 'z Lo�, f3 2� RVr no � S�lzs �oi �oo �I ��S� <br /> LEGAL+�r new construclion: Shorl PlaVsubdivisionHlLToreS .Z U� A DD Lot No.�� (at�ach copy of long legal descriplion) <br /> OWNER /n RT'1 C. (Z I S I. C P- Phone/E•mail <br /> Address 1 y 3'L �p m (3q 12.,� S� Ci�y/S�ate2ip E yY 2G. T�I W H r'I �0 1 <br /> CONTRACTOR R LL � m R j E N>G f� R L&I Lic.# K1 L(. � 9 L <br /> Adtlressl7s� "7 �� 7�1,. T ✓�E ��++oUD 9K05Z Phone/Email �/ a —7�lU��O � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> SI�, No �-ISG n� �-! z5� � �1 /v - 30 ']9 <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $U(/D <br /> Exisfing Use of Building SF. HEAT SOURCE: <br /> Proposed Use of Building Gas� Electric_ Other,_ <br /> Building type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DescriptionofWork(additionalspaceprovidedonfheback): ���,�� .�,y�,��v ��,,;Lt� •�.,��J ��� <br /> - �-r} ,�:,,�z... �� •�t.�s,.,-.-p-L�� 7„`�,.crx�.�-� c.,.,,..Q h..�•-•-v�'�' <br /> Have you started working without a permitl _YES X NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeoiProjoct: _New_Addn,�Alteration_Repair TypoofProject: _New_Addn _Altoratfon_Repair <br /> Show Num6er(#)o/fixfures Show Num6er(#1 of�atures <br /> _ � A/C—air h�ndling units = � Toilel <br /> Forced air systems Bathtub <br /> 3 � Gas piping _ � � Lavatory(wash basin) <br /> Water heater _ Shower <br /> � Gas fireplace _ Kitchen sink 8 disposal <br /> Gas range � Dishwasher <br /> Clothes dryer _ � Clothes washer <br /> � Range hood Water heater <br /> — ---Sink-(service/bar/mopletc) ----- - - <br /> � -- —Exhaust fan- --- —- - - —--- <br /> � Heat pump _ Backflow preventer <br /> _ � Unif heater Urinal <br /> � Boiler Drinking Fountain <br /> Refrigeration Floor drein <br /> � Woodstove _ Grease trep <br /> Ducting _ Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM ._ I other <br /> Number of Heads — <br /> i hereby certify that I have read and examined this applicalion and know the same to be true and cortecl.All provisions oi laws and ordinances goveming <br /> this type of work will be complied wilh�Nhether specified herein or not.The granling of a permll does nol presume lo give authority to violate or cancel <br /> the provisinn of any other slale or Iocal law regulating construdion or lhe pertortnance of consiruction.Thal I am authorized by the ovmer of ihis property <br /> to pedortn the work(or which application is made and I comply with lhe S�ate Contractors Law 1827 RCW and 296200 WtiC <br /> � ��'�,�'" � i �zzai <br /> O r/AuthorizedAgenliJ(gnature Date (Revisetl1220f0) <br />