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' PERMIT APPLICATIG�� <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES �J�-D"7--(( <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8`10-FAX 425-257-8857-www.everettwa.org <br /> MPLICATIONS ARE ACCEP7ED FROM S AM TO 4 PM <br /> SITEADDRESS: PROPERTYTAXII PERMI , � <br /> 1 033 PAIrJE FIGiO WhY Ev�RE�� WA :..��1 <br /> LEGAL br new wnstmction: Shon PlaVsubdivision�i53u57L,Yc��II_g6e1_.i�i._Lol No.__l (atlach copy of ionp leqal description) <br /> OWNER _ �_ ;,M—cS NW 11C Phone/E-mai� �`iZS� 33Pi -552 d <br /> Address rJ 6�X 14�12`i City/Sla�e/Zip (`n�� �.wEEK V.f/1 `f{o�2 <br /> CONTRACTOR Lo;7r.1=R5-tt�ra �-�cM�s N�J U.0 L81LIc.# C�%RNcHN94� CA <br /> (4i5 �i3. -S.�i: <br /> Aedress Po 6<n ���`{2y �'l�u CREEk �!k `I�UtZ Phone�Emai� .�nn��;�N-.SyN=HJ��IES,US <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Mq� �M P��R <br /> Phone/E-mai� <�125�33�-5555 M+�QG-rtN"F�nnr_Hwn�S.�.iS <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF woRK <br /> EKisling Use of Building__ _ HEAT SOURCE: <br /> Proposed Use of Building __ Gas_x_ ElecSric____ Other____ <br /> Building type: X Single Family __Duplez_Townhouse _Multi-Family _Commerciai <br /> Type ot project �New _Addition __Remodel __Repair__T.I._.Sign_Sprinkler__Demolition_Change of Use <br /> Descriplion o(Work(addifional space provided on fhe back): <br /> �J�'S IG � � I 2. � I-�.14'h� I� 1 J �' <br /> Have you ataAed workinQ without a pertnil7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pro�act: �New_Addn __ Allerrilon__Rapalr Typa of ProJact: �N�w_ Addn _Altanllon__R�pair <br /> Show Number R o//Irtun� Show NumMr k ol flutunt <br /> A/C—air handlin units 3 Toilel <br /> Forced air s stems 2 Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> � Gas fre lace 1 Kitchen sink 8 dis sal <br /> Gas ran e Dishwasher <br /> Clothes d er 1 Clothes washer <br /> Ran e hood Water heater <br /> y Exhaust fan Sink service/bar�mo /etc. <br /> Heat um BackFlow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other_____________ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM olher: <br /> Number of Heads Other: <br /> I hereby ceAify that I have read and ezamined this applicalion and know lhe same to be Irue and cortect.All provisions ol laws enC adinances goveming <br /> Ihis lype of work will bc complied with whether specified herein or nol.The granting ol a pertnit dces nol presume lo pive authotity to violate or cancel <br /> Ihe provision o(any cther state or local law regulating construction or fhe pertormance ol conslruction.Tha�:nin authonzed by lhe owner ol ihis property <br /> to peAorm Ihe wurk for wfiich application is made and i comply with the Slate Conlractors Law 7B.2T RCW end 296.200 WAC , / <br /> 4(?Ai �at.�'�cY� $ �I$ �I l L <br /> OwnerMuthodzed Agent Sipnatura Date (Revised 2/2011) <br />