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• <br />PERMIT APPLICATION <br />BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 wvlw.everethva org <br />SIT�G,fQJ1DD E S: �✓Iff- � / <br />PROPERTY TAX # <br />PE hlT O `� d <br />i� <br />LEGAL for for new construction Shon Platisubdivision lot No._ (attach copy of long legal ddeescnpfon) <br />OWNEI7� QUSI./1 t,i 6R 1'j <br />Phone1E-m V <br />Address' �L Ti2f j <br />,,QQI <br />Gty/Slate/Zip f J'/- A. <br />APPLICANT:_Owner —OwnersAgent Con/tractor Contractors Agent Tenantrt/mv:�pronao apkncrmnco�nlscni ::on gw owcenodo woo tome space) <br />SCAR._ CA) /i �/ Stale LicTC/�� %� /Cv7 City Bus. Lid. # <br />CONTRACTOR C, <br />jPhor,e1Erna,Ibj'd'& <br />(j,4Address (, Q 0 Q ,�� .d2./✓ ST �C lOJ <br />TENANT BUSINESS NAME <br />r <br />CONTACT FOR PERMIT <br />I/ ,� 'r QQ <br />C'� QG/ <br />O <br />Phone/E-mail �7� /lie <br />BUILDING PERMITt PLICATION <br />CONTRACT PRICE OF WOTRA_ <br />Existing Use of Building H T 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 _Sprinkle _Demolition Change of Use <br />_ _ <br />SCRIPTIONOFWORK(addihonalspaceprovidedontheback) t n�/Iak+eF� <br />��(, S�,N Pu 17C A��, f % i/I�fGI) r V <br />F,17Q 1/rC q t2iJaC �` I� rp r(- /QG�bJ 4 -S <br />MECHANICAL PER IT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project: _New _ Add n Alteration _Repair <br />Typo of Project: _Now _Addn _Alteration _Repair <br />Show Number(# of fixtures <br />Show Number (a) of fixtures <br />I A/C — air handling units <br />I Toilet <br />I Forced air systems <br />Bathtub <br />Gas piping <br />I Lavatory (wash basin) <br />Water heater <br />I Shower <br />Gas fireplace <br />Kitchen sink 8 disposal <br />Gas ran a <br />Dishwasher <br />Clothes dryer <br />I Clothes washer <br />j <br />Range hood <br />I Water heater <br />Exhaust fan <br />I Sink (servicelbarlmoplelc.I <br />Heat pump <br />Backflow preventer <br />Unit heater a 2d AC <br />Urinal <br />I <br />Boiler <br />I Drinking Fountain <br />I <br />Refrigeration <br />I Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains , <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby cemy that I have read and examined This application and know the same to be true and cones. All prowsions of laws and ordinances governing this type of work win be compiled <br />with whether specm nereinor nol. The granting o1 anon aces not presume to give authority to vOrale or cancel the provision of any other state or local raw regulating consuuction <br />That 1 am auto ed bgthe owner of this proper�t fJ rfolm the work lot which application is made and I compty with the State Contractors Law 16 27 RC W and 296.210A WAd. <br />OlyL,.'i—A n,w.,.1 C nTnahrrn ! (Revrsed 312013) <br />