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' � PERMIT APPLICATI�J <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLIT!�nl <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320� Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM <br /> SITE ADDRESS: PROVERiY TAI(II PERMIT <br /> Ilo�/t 1�PirJE FIE�D WhY EvcQE�� W� b..�;"I � <br /> LEGAL lor new conslruclion: Short PlaVsubdivision�53uS�y2�gG�S�—Lot No_�1_ (attach wpy of long lepal CescAption) <br /> OWNER _ �� ;N� NW �i.0 PhonelE-mail �425� 33� 'S5�G <br /> Address (�o $�x 14'�2'i City/StatelZip M�,.� CP.�K WA 9i��� <br /> CONTRACTOR C.o;� =r s � �-�oM'c5 N�� U-C L 6 I Lic.k C:;It N c H N 9 4 l �% A <br /> C4z�. 33�-S:oe <br /> Addres� PU Qu7 ���`j2y (�11u C�EEk �l�4 9'rU��2 PlronelEmail .�qn��:�N„S�uN:HoM�S.uS <br /> TENANTBUSINESSNAME CONTACTFORPERMIT �„�qr ,MPu�� <br /> Phone�E-mail ��iZs�33'�-SbSS MRrec..RN"C�nnr_H..fn�S.uS <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Ezisling Use of Building�_ __ HEAT SOURCE: <br /> Proposed Use of Building _ ___-- Gas_X_ Eiectric____ 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 /> Descriplion of Work(addi!ional space provided on fhe back�: <br /> 6�s�� -#- y i 3 � P�+� » c�� B) <br /> Have you started working without a permit7 __YES _�NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Pro�eet: `�New_Addn __ Allenlion___Repair Typa ol ProJacl: �New__ Addn _Alhntlon__ R�pdr <br /> Show Number N�o/flrturni Show Number N o/flrtuns <br /> A/C—airhandlin unils 3 Toilet <br /> Forced air s stems 2 BathWb <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace � Kitchen sink 6 dis sal <br /> Gas ren e Dishwasher <br /> Clothes d er / Clolhes washer <br /> Ran e hood Waler heater <br /> y Ezhaust fan Sink servicelbar/mo /etc. <br /> Heat um Backflow reventer <br /> Unit heater Unnal <br /> Boiler Drinkin FouMain <br /> Refri eralion Floor drain <br /> Woodstove Grease hap <br /> Duclin Rool drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> � Number of Heads Othsr: <br /> I hereby ceAr�ihat 1 have iead and eKamined Ihis application and know lhe same lo be true and wrtect.All provisions ol laws and adinances goveming <br /> ihis type ol vrork vnll be complied with whelher specified herein or nol.The granting of a pertni�Ooes not presume lo give authority lo violate or cancel <br /> the provision ol any olher stale or local law regulating construction or the peAormance ol construc�ion.Thal I am authorized by lhe oNner ol this property I�� <br /> to pedorm Ihe vrork lor which application is made and I comply wilh Ihe Slate Contracbrs Law 1827 RCW and 2962D0 WAC � <br /> 1�„� �,,,�✓ aj�s ►�� <br /> OwnerlAulhorized Agenl Signature Date (Revised 212011) <br />