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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 -- AvAv.everettwa.or � `I <br />PIE ACCEPTED FROM R AM TO 4 PM ) a <br />SITE ADDRESS: / PROPERTY TAX it PgRMIT#n� �Oj <br />3Y,31 lonf6",rf A� � L' <br />LEGAL for new construction: Short PlaVsubdivision Lot No._ (attach copy of long legal description) <br />OWNER -%j h ,Z e• Phone/E-mail y.,?S — 3 3 0— 7 7 7 3 <br />�rO <br />PO T� i City/Stale/Zip <br />Address r� o f <br />CONTRACTOR L & I Lic. # <br />Phone/Email <br />Address <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />F+hone!E-mail Sri /r�r-C <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK_1 6: <br />I 1�Gli HEAT SOURCE: <br />Existing Use of Building �2.�-.+'f-� <br />Proposed Use of Building Qt.r+`' SFi2- Gas_ Electric Other_ <br />Building type: Single Family Duplex ,_ Multi -Family _ Commercial <br />_Townhouse <br />Type of project: _New _Addition /�<_ Remodel _Repair_ T.I. _Sign _Sprinkler_Demolilion_Change of Use <br />Description of Work (additional space provided on the back): .n �p('� ryt oy s y X A S•iy erg{ 13,l, (a i .cc, <br />Have you started working without a permit? YES __NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: <br />_Addn _Alteration _Repair <br />Type of Project: _Now <br />_Addn _,Alteration _Repair <br />__Now <br />Show <br />Number (#) of fixtures <br />Show <br />Number (#) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced air systems <br />Bathtub <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />Sink (service/barimop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Ducting <br />Medical Gas <br />Other <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing <br />this type of work will be complied 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 state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform the work for which application is made and I comply with the State Contractor, Law 18.27 RCW and 296.200 WAC <br />Date (Revised 2/2011) <br />OwnerlAuthorizod Agent Signature (/� <br />