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� � � PERMIT APPUCATIG�� <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES q...Q��...(� <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM T01 PM <br /> SITEADDRESS: PROPERTYTAxIt P ITf _ <br /> 1 0 1��WE FIELO WFY EVERcr WA °....�i�7 � <br /> LEGALfornewconstruction: Short?IaVsubdivisionC.:wliiS�.yE ��Ggy�_LotNo�� (attachcopyollonpleflatdescnption) <br /> OWNER " _ „i_ ;,M�S NW 1_t_C Phone/E•mail (`1z5� 33°i 'S5�'L <br /> Address Po 6.�v 14'�2'1 City/Stale/Zip M�..� C.w�K WA y;.a22 <br /> CONTRAC70R C-o;t �:s-ci.r �acM�S N�� l_1.0 L 61 Lic.lt C�:RN E H r� `14� U A <br /> Cvzs i>�-s.�e <br /> Add:ess PU 6u�. ���y2y ��lu C+".EEk �1.4 9YU�t2 Phone/Email .�An�.c.�Nc.StiN��+�MES.uC <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �„�qr �h�P��-A <br /> Phone/E-mail \y25�33ti,-5555 M�t�TQc,.RHEC�nMNw+�ES.U$ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Ezisting Use of Building___`__.____— ___— HEAT SOURCE: <br /> Proposed Use of Building_____-- Gas_X_ E�ectric____ Other____ <br /> Building type: X Single Family __Duplez_Townhouse _Multi•Family _Commercial <br /> Type of project: _�New __Addition _Remodel _Repair�T.I._Sign_Sprinkler_ Demolition_Change of Use <br /> Description of Work(additional space provided on 1he back�: <br /> 13�5« t�- 412 �i�� I'I� S a) <br /> Have you atarted working without a permit7 __YES _�NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa o1 Projeet: )�New_Addn __ Alleralion__ Rapalr Type of ProJect: _�Naw___Addn _Allentlon_Repalr <br /> ShowNumber N o/Portures ShowNumMr / o//Ixtun� <br /> A/C-air handlin units 3 Toilet <br /> Forced air s slems 2 Bathtub <br /> Gas i in Lavato wash basin <br /> Water healer Shower <br /> Gas fire lace t Kitchen sink d dis sal <br /> Gas ren e Dishwasher <br /> Cbthes d er / Clothes washer <br /> Ran e hood � Water heater <br /> y Exhaust fan Sink service/bar/mo /etc. <br /> Heat um Backflow reventer <br /> Unit healer Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease lra <br /> Ductin Roof dreins <br /> Other_______________ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certi(y�hat I have read and ezamined this applicalion and know ihe same to be Irue and conect.All provisions of laws and ordinances paveminq <br /> this lype ol work vnll be complied vnth whether specified herein or not.The granling ol a pertnit does nol presume to give au�hority lo violate or cancel <br /> Ihe provision of any other state or local law regutaling constn�ction or ihe peAortnance o1 wnstruclion.That 1 am authorized by the w�ner of thia property <br /> to peAorm Ihe work for wfiich applicalion is made and I comply with ihe State Contraclors Law 18.27 RCW and 296200 WAC � <br /> �� �� <br /> 7'I?�„ �+r�tP� $'I S �11 <br /> OwnadAutbod[ed Agent Signatun Dale (Revisetl 2/P011) <br />