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�. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIP�.UMBING/SIGNISPRINKLER/DEMOLITION <br /> CiTY OF t�lERETT PERMIT SER.VICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: PROPERTYTAX# P RMITp <br /> ,�i�� n� (_�,�L„� P.� v�-+3 r3�i�� io� v� �o 00 <br /> LEGAL for new ronstmction: Short PlaVsubAivision Lot No._ (attach copy ol long legal descnplion) <br /> OWNER L�� yG�� �- �—LG Fno�ere-ma�i s41-3 .-4163 da.,qw,;�l�e/��"' vt���. c�wt <br /> Address �n ��"`< � �Z I CitylState/ZiP �'}p�� K�vf G� ��U/ <br /> qPPLICANT:_C�mer Ovmer'sAgent �Comnctor Coniracbr'sAgent _Tenant�m�sio�o.�aeaiene�arm�.e�i��ommeo...�e�ioao�.o�����eso�+:ai <br /> CONTRACTOR I �TJ L&I Lic.# COE Bus. Lic.# <br /> Address PhonefEma�l <br /> TENANT BLISINESS NAME CONTACT FOR PERMIT <br /> r/ r� Phone�E-mail S`T)«L ;��s �U�✓� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '}LOoo <br /> Existing Use of Building SF{2 HEAT SOU`RCE: <br /> lF� Gas Eleciric T Olher_ <br /> Proposed Use of Building � — — <br /> Building type: �Single Family _Duptex_Townhouse _Mulli-Family _Commerciai <br /> Type of pro'ect: New Addition Remodel Repair T.I. Si n Sprinkler Demolition Chan e of Use <br /> DESCRIPTIONOFWORK(additiona�spaceprov�dodonmoback): „ ��� ^,M1 � <br /> '` � W� <br /> � <br /> r,. ,�� Y � �+l - ��� No�i-��Pnvv�'� �'�f�2�cV lNc4 �S !ih i <br /> ti <br /> Ir �, i , n i r _ <br /> � ' � :�'.;}t� . <br /> f� � ��'^ � <br /> �;..__� . ;-.rr �� ���1� �r.1- ��3 =ti� � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa a1 ProJect: _New_Addn _Alteratlon_Repalr Type of Pm�ect: _New_Addn _AlteraUon_Repair <br /> Show Numbe�(bl o((x(ures Show Number(#)o/!:.mres <br /> � A/C–airhandlinc�uniis I Toilet <br /> � Forced air sys�ems Bathtub <br /> I Gas pi in I Lavatory wash basin) <br /> Water healer Shower <br /> Gas fireplace � Kitchen sink&disposal <br /> � Gas ranqe I Dishwasher <br /> I Clolhes dryer CloUies washer <br /> •, I " I Range hood � I Water heater <br /> �i Sink(servicelbarlmopleic.) <br /> I ' � Exhaust fa� <br /> Heat pump � Back9ow preventer <br /> � Unit heater I Urinal <br /> �I Boiler Drini:in Fountain <br /> i Refrigeralion � Floor drain <br /> � Woodstove I Greaset�ap , <br /> � Ducting ! Roof drains <br /> ' O�her_ : Medical Gas <br /> SPRINKLER 1 SUPPRESSION SYSTEM I Other: <br /> ' � Number of Heads � Other. <br /> jI i�rnr0y cerUh I�al I havn reaJ and exammeJ Iros aVPlealbn and know the same lo be Imo and conacl.NI p�uvis�ons of I.uvs and oidinances goveming th6 type of wor4 w�Y be compbeJ <br /> ,�nn wM1elher spacdied hetain or nol.The granFng ol a pe�=��does nol Drasume la 9ive auihonty lo violalo or cancel lhe piov�son oi any clner stale ur lowl law wguWtin9 ronstmr.eon <br /> lnat 1 am,utho�izotl Oy Iha ownor ol l�is property to pom,nn tho work lorvrtiw�aDGl�ealan Is maGe antl I eompH�*^'����'�e S:a�o Con:r.dors Law iP 77 ftGl'J and 296100A WAC. <br /> � <br /> ,, �/5 13 <br /> ; ---'— ( (. � iv�..�,:.�:,-,.. <br /> Ov.noi,.� AhodzedAaontSlgnature Date (Rnvisod6�2012) <br /> \/� <br />