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PERMIT APPLICATION <br />BUILDING ECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 - www.everettwa.org y <br />�rnue &ee &nncnTcn cony a AY Tra A PY b , -) "a <br />SITE ADDRESS: <br />26.70 -G,0.41, W 'iC 1 <br />PROPERTY TA%N <br />0043916.160/60-3 <br />P <br />7177 <br />LEGAL for new construction: Short PlaVsubdivision Lot No._ (altach copy of long "at description) <br />OWNER /'Lech &? /7tc,-7S <br />PhonelE-mail <br />Address Z�,,�c� - L4Z-'4 H� ��E' <br />City/Slate/Zip <br />CONTRACTOR �Ju or CC -,fry <br />.,[ <br />C y,- '` 22 r— <br />L&ILic.# GCh <br />Address Phone/Email <br />TENANT BUSINE S NAME <br />CONTACT FOR PERMIT _7y-c0t..�,ea�r <br />,, <br />Od 5**— c26 .3- <br />� <br />Phone/E-mail .L' <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building -S FiC' HEAT SOURCE: <br />Proposed Use of Building Gas Electrc Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project. _ New --Addition _ Remodel _X Repair _. T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />Description of Work (additional spa-^ orovided on the back): <br />{70 <br />c�Q:r/• Co.aS>�nyCf l�r'c,E ¢ S pS Apff"' ✓moos . <br />Have you started working without a permit? AYES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (a) of fixtures <br />Show Number e) of fixtures <br />A/C - air handling units <br />I <br />Toilet <br />Forced airs stems <br />Bathtub <br />Lavatory wash basin <br />Gas piping <br />Water heater <br />Shower <br />Gas fire lace <br />Kitchen sink & disposal <br />_ <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes her <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Floor drain <br />Refri eration <br />Woodstove <br />Grease trap <br />Ductin <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER if 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:rue 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 provi%lon of any other stale or local law regulating construction or the performance of construction. That I am authorized by the owner of thin property <br />to perform the work for which application is made and I comply with the Stale Contractors Law 18.27 W�r+A�RB-2G0. C <br />Owner/Authorized Agent Signature Dale �� �S (Revised 2/201 f) <br />