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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBIN G/SIGN/S'PRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVIVES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 42E-257-8857 www.everettwa.org <br />Farm FROM N eIu TO d PM <br />APPLiCHIiGriJ nnc n-. <br />, <br />SITE ADDRESS: ,l <br />)42(,, Z'/q-e� <br />PROPERTY TAX If <br />P <br />MIT# <br />zoo-01 <br />LEGAL for new wnstruction Short Plat/subdonSion <br />Lot No.__�7 (attach copy of long legal description) <br />OWNER v�� C� r r,C/ Tom- <br />Phone/E-mad , �<'-303/le2 <br />� <br />� `^— <br />City/StatelZip 1!5�LcF7 t/J <br />Address C <br />_ <br />APPLICANT:_ Owner Agent Contractor _ Contractors <br />Agent _Ten.inl lmuv lxo�de.. knerau'ns�"h°m m°a...,ermao+.wknma sp,al <br />_Owner's <br />L & I Lic. # CJr� 70bS COE Bus. Lic. # 0-56 25-7 <br />CONTRACTOR /' /Ytc`+ _ YC <br />Address S1� - Q�� <br />PhonelEmail �'o <br />_ <br />TENANT BUSINES NAME <br />CONTACT FOR PERMIT <br />O � 2< <br />` <br />BUILDING PERMIT APPLICATION <br />Phone!E-mat <br />CONTRACT PRICE OF WORK <br />HEAT SOURCE: <br />Existing Use of Building <br />Gas_ EleUuc_ Other_ <br />Proposed Use of Building <br />Building type: Single Family X Duplex _ -Townhouse _ <br />Multi -Family _Commercial <br />_ <br />Type of project: New Addition Remodel Repair <br />T.I. Sin Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />` <br />IMECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Addn__Alteration_Repair <br />Type of Project: dra ration_Repair <br />_New <br />Show Number (#) of fixtures <br />ShowNumber ofFixtures <br />Toilet <br />Bathtub <br />I <br />A)C — air handling units <br />I <br />Forced airs stems <br />I Lavatory (wash basin) <br />Gas piping <br />Shower <br />I Kitchen sink a disposal <br />Water healer <br />Gas fireplace <br />Dishwasher _ <br />Gas ra le <br />Clothes dryer <br />Clothes washer <br />Water heater <br />Rancie hood <br />Exhaust fan <br />Sink (service)barlmo /etc.) <br />Heat pump <br />I Backnow preventer <br />Unit heater <br />Urinal <br />Boiler <br />DrinkingFountain <br />Refri elation <br />Floor drain <br />Wocdslove <br />I Grease ha <br />Roof drains <br />Ducting <br />Other <br />Medical Gas <br />Other: <br />SPRINKLER I SUPPRESSION SYSTEM <br />Number of Heads <br />Other: <br />hereby Fealty that have reatl and examined this application and know the same to be time and mnect. AN provisions of laws and ordinances governing to is type of work will be complied <br />win whether specified herein or nol. The granting of a period does not presume to give authonry to violate or cancel the pmvisgn of any other stale or local law regulating conslmdron <br />That I am ulhonzed by ovmer of thisOpIpendoen the work for whim application is made and I comply%In the State Contractors Law 10 27 RCW and 296.200A WAC. <br />' (Revised 612012) <br />ner/Authorized Agent Signature Date <br />