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PERMIT APPLICATION <br />BUILDING/MECHAi'SiCAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />n FROM a AM To d PM 7 -a-U-/Z <br />AY1'LtUA I Iona rxn� nx.x. ter- - <br />� h11T <br />SITE ADDRESS: <br />� <br />PROPERTY TAX 11 <br />LEGAL for new construction: Short Plat)subdivis!on <br />Lot No._ (attach copy of long legal description) <br />OWNER IG L--SIC r ns <br />PhonelE-mail 330- <br />Address 10, %1., c = / [' <br />City/Slate/Zip Z[) <br />APPLICANT: __�L Owner _Owner's Agent _Contractor _Contractor's Agent —Tenant (must pmnaeaitmeroiconfenlimmmeewnertowwoM tntha spare) <br />L & I Lic. # COE Bus. Lic. If <br />CONTRACTOR 4c <br />Phone/Email S4. ! <br />Address IN i <br />CONTACT FOR PERMIT <br />TENANT BUSINESS NAME <br />g C 1ti-Y� <br />Lie, <br />Phone/E-mail sc I f rz 4 AP1.Vf yrr 4F ^Co - <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK nab ro <br />HEAT SOURCE: <br />Existing Use of Building 4 t <br />Gas_ Electric_ Other_ <br />Proposed Use of Building )-� <br />Building type: Family _ Duplex _Townhouse _ <br />Multi -Family *- Commercial <br />=Single <br />Type of project: New _ Addition Remodel Repair <br />_ T.I. _ Sign Sprinkler Demolition —Change of Use _ <br />DESCRIPTION OF WORK (additional space provided on the back): <br />Add d�vrsing w�! I <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project: _Addn ,_Alteration _,Repair <br />Typo of Project: —Now __A d —Alteration _Repair <br />_Now <br />Show Number (0) of fixtures <br />Show of fixtures <br />A/C - air handling units <br />Toilet <br />l Forced airs stems <br />Bathtub <br />( Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />Kitchen sink & disposal <br />Gas fireplace <br />I Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />I Water heater <br />Range hood <br />Sink (serviceibadmop/etc) <br />Exhaust (an <br />I Bac kilow prevenler <br />Heat pump <br />I Urinal <br />Unit heater <br />I Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />I Grease trap <br />Woodstove <br />Roof drains <br />Ducting <br />Medical Gas <br />Other <br />Other: <br />SPRINKLER /SUPPRESSION SYSTEM <br />Number of Heads <br />Other: <br />1 hereby certify that I have mad and examined this application and know the same to be true and coned. All provisions of laws and ordinances goveming this type of,ark mil be ccmpired <br />"Is whether specked herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the comer of this property to perform the wofk for which application Is made and I comply with the State Contractors Law 16.27 RCW end 296 200A WAC. I <br />�7(Revised C✓2012) <br />b'-� Z <br />Winer/Authorized Agent Signature <br />Dale <br />