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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPR INKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St , Everett. WA 98201 425-257-8810 FAX 425-257-8B57 www.everettvia org <br />APPLICATIONS ARE ACCEPTED FRON 8 AM TO 4 PM <br />SITE ADDRESS: <br />3scT3 OtiK�s /1 <br />PROPERTY TAX IT <br />PERf:,1T # <br />LEGAL for new constructionShon PlaYsubdiviston Lot No (attach copy of long legal descrplion) <br />OWNER Sc! - tFdi—, .4 r PhonelF mad YZ s - Z9 -7 -S-c) v } <br />Address 3 S O 3 Oac-r Cay1SSIe1Z,p t..--ram- rr, L✓/-1- % B 2 O <br />APPLICANT: `Owner OwneYSAgent Contractor _ Contractor's Agent Tenant l,wnp,o.xeawnr ofrmse^I vein e,o owaero aQ.onnw.oanl <br />CONTRACTOR (7x.r.-..e+ <br />L 8 I Lic. # COE Bus Lic. # <br />AdNcs PhorceEmad <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />S" C-�t--.--1 S <br />Phcne/E-ma'I v 2- : - 7 `t i - S " `I` -?- <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK_ <br />E. sling Use of ButkLng 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 _5 rinkler _Demollhon_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) . <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Adds _Alteration _Repair <br />Show Number (9) of firzures <br />Type of Project. _New _Adds _Aherabon _Pepair <br />Show Number le) of I/rturrs <br />A/C -air hand) ng units <br />Todel <br />_ <br />Forced au systems <br />Bathtub <br />Gas piping <br />I Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink 8. disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Ran c hood <br />Water heater <br />_ <br />Exhaust fan <br />Sink (setvicelbadmop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boller <br />Drinking Fountain <br />Rclriaeralian <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other - <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />Other. <br />I hereby cealy that I have read and examined this application and know the same to be free and correct AM provision, of laws and ordnance3 geveming this type Mwork we be compaed <br />with wbeNer speidited herein or not. The granting of a permit does not pa some to give auihonly to violate or cancel the provision of any Quiet stale or local law regutahng ei,nslruction <br />That 1 am authorized by the owner of IN Property IQ perform the work for which appicatnn Is made and I comply win the State Con:mcton Law to 27 RCW and 295 LJOA V'AC. <br />OwnerlAuthorized Agent Signature Dale <br />(Revised 6Ro12) <br />0 <br />