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PERMIT APPLICATIOt� <br /> BUILDING/MECHANICAL/PLUMBING/SIGNI�PRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425•257-8810 FAX 425-257-6857 www.everettwa.org <br /> SITEAODDRESS'� � �. PROPE1R7Y,l�l(N�J 1 U�O� P/fiRMITA !W <br /> a E - :� �+ �� <br /> LEGAL lor new construclion� Short PlaUsu�division Lot No._ (anac�coDY ol long Icgal Cescnplion) <br /> OWNER�ry,�II��'F" hGI MEYUC�� Phonei[�mail �il�J�Z57'�I7✓ wwmeruer_5�msn.com <br /> Adaress ��g i 7V� CitylStale2ip�e1-�{- W� pig2o3 <br /> APPLICANT: �.Owncr Owner'sAgent Coniiactoi ContractofsAgenl _Tenant(mm�c:=�naoa�er.c�c+m�:�oirc:meno«��ruco.o��nmos;.,:o� <br /> CONTRACTOR � `" State Lic.# City Bus. Lic.# <br /> Address PhonMEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Wallic� Mer uer <br /> � Phone/E-mail y •?r?-9173 wW►�ruer_5�►hsh'� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WOR �=�;000 , <br /> Existing Use of Builtling�� nS i !l7 HEAT SOURCE� <br /> Proposed Use 0f Buildinq m _ Gas__ Eiectnc _ Olher_.__ <br /> Building type: ,�Single Fa��ily _Duplex Townhouse _Multi-Family _Commercial <br /> Type of pwjecL New ,10dAion Remodel Repair_T.I._Sign_Sprinkl emolition_Change of Use <br /> DESCRIP'fION OFV�ORK(adr:nona�s�ace prov� ed on tne eackl:h'2plC��cQh[r'f.le fUl.��4YloY1 R� Ull°5hehd OE I�Ui lA�r�a <br /> high levation. FbursiKn�w�ierpc�fix�h�h perpWn. 9rr-mgthe S+n.+ctureby luett'tiin C�xF�'n'or <br /> wGt��tt�eFYjFhenat�Ch►NcnlSot= PX�Sh'no��fi^ct�mrnq Qndsitlp�alespe�'(�1��.�r�tner�rnainf�' <br /> Amin per plan.CoSmeh�r rn�e oF tiomP. qdci wali5 for dosels etc.ue� ptumb �9,eiecrn'cQ� , <br /> insula�on,�vyunu• D <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIGATION <br /> Typo ol Projecl: New_Addn _Alterotion_Ropair Typo 01 Pro�oct: �Now_Addn _Alteratlon_Ropair <br /> Show NumDcr(NJ o//ixfures Show NumCer(N)o/lirtures <br /> A/C—airhandlingumis ( Todet <br /> Forced air systems I BatMub <br /> Gas i Ing � � Lavatory(wash basin) <br /> � Water heater � Shower <br /> Gas freplace � � Kitchen sink 8 Aisposal <br /> � Gas rangc I Dishwasher <br /> I Clothes dryer I � Clolhes washer <br /> � Range hood � � <br /> Exhaust fan Sink(scrncelbar/mop/ettJ <br /> Heat pump � BackOow preventer <br /> UnA heater Urinal <br /> � 6mter I Drinking Fountain <br /> � Refrlgeration I Floor drain <br /> Woodstove Grease irap <br /> ' Ducting � Roof drains <br /> Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> Numher of Heads � Other: <br /> I ne�eby cenrty mat I have ieaJ ond eram�ned this appliw;ion and know U,n same l0 6e Ime ond wrmtl A1 pmrsions ol laws ontl orEinan[es goveminq i�is type ol woik x�tl Ee comDlieO <br /> wnn wnclM1er speaflea he�ein or not 70o prant�ng ol a pertnit does not Dresumo l0 9ivo aN�omy to�io�ate or cancel tno pmvision al acy ciher slale or lowl law regula�ing consl�uC,ion <br /> Tha�I am authon:ee Oy O:e owner ol Inif pmpeny lo peAorm I�r xork lor HMcn appi�wlian it maCe an�I wmply wnh Ihe 51aIe Canlrucbn Law 1B Y7 ftCW a�0 296 200A WAC � <br /> / L!�:^l,J/ � 1/ <br /> � � 2 <br /> / /� /3 <br /> �wnorlAuthorixed Agont Signaturo Date (Revised 3l1013) <br />