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PERMIT APPLICATION <br />BUILDING/MECHANICAL/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 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I — 5 _ )' <br />S410 QPVE AVE. <br />1 FZ7/l/61 - Obi <br />LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br />OWNER SC. -RAN % <br />Phone/E-mait L4 - X 12-- OQ <br />Address PA 9oX 3 U <br />City/State/Zip SV=LLE 9'89-70 <br />CONTRACTOR <br />L 6 I Lic. # <br />Address Phvne/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT MO RG ez-so 771 <br />Phone/E-mail 34 O ,4 <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />Description of Work (adddtonal space provided on the back): . <br />8(45Ei�lEtQT(S�ZbR� C)&)L r <br />Have you started working without a permit? _YES __NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Now_Addn _Alteration _Repair <br />Show Number (N) of fixtures <br />Type of Project: _Now_Addn _Alteration _P -pair <br />Show Number (0) of fixtures <br />A/C - air handlingunits <br />Forced ai; systems <br />Toilet <br />Bathtub <br />_ <br />Gas piping_ <br />Lavatory (wash basin <br />_ <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />_ <br />Range hood <br />Water heater <br />_ <br />Exhaust fan <br />Heat pump <br />Sink (service bar/mop/etc.) <br />Backflow preventer <br />_ <br />_ <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ductingof <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease tra <br />drains <br />_ <br />SPRINKLER <br />Other <br />/ SUPPRESSION SYSTEM <br />_ I <br />Medical Gas <br />Other <br />Number of Heads <br />I hereby certify that I have read and examined this application and know the same to be true 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 provision of any other slate or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />1 pper R 6he r a rOw; h aapplication is made and I comply with the Stale Contractors Law 18 27 RCW and 298.200 WAC <br />N 1- -III <br />OwnerlAuthorizc gent Signature Date (Revised 1212010) <br />