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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/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 />SITE ADDRESS: <br />PROPERTY TAX IfR0 <br />If <br />PC MIT O 0061i <br />LEGAL for new construction Short Plat/subdivision Lot No. (altachh copy of long legal description) <br />OWNER W� <br />LL <br />iI <br />PhonelE-mail I <br />Address / <br />City/stitelZip iA114 2. <br />Agent Contractor _ Contractor's Agent Tenantlmivmwdeao-coofmmem,".emm. owner tpeoworxm na scacol <br />APPLICANT: —Owner m <br />CONTRACTOR <br />�_Owner's <br />D� <br />State Lic.#` City Bus. Lic. # r <br />Address T�. L O% , <br />'IS V•7 <br />Phone/Email <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />Phone/E nail ( �rl r�QsT^ <br />I <br />BUILDING PERMIT APPLICATI 3N CONTRACT PRICE OF WORK Z V <br />Existing Use of Building HEAT SOURCE. <br />Proposed Use of Building N�`� I" �� _ 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 (additional space provided on the back). <br />p <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: ,KNow _Addn _Alteration _Repair <br />Show Number (0) of fixtures <br />Type of Project: _New _Addn __Alteration _Repair <br />Show Number (#) of fixtures <br />NC - air handling units <br />Toilet <br />Forced air systems <br />I <br />! Bathtub <br />Gas piping <br />Mt <br />! Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace . <br />. <br />Kitchen sink & disposal <br />Gas range • <br />Dishwasher <br />Clothes dryer 1 <br />Range hood <br />r <br />Clothes washer <br />--WaTCTTteaTer- <br />/4 1 <br />Exhaust fan tTV <br />. <br />Sink (service/bar/mop/etc I <br />Heat pump <br />Backflow preventer <br />Und heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />! <br />Refrigeration <br />Floor dram <br />Woodstove <br />I Grease trap <br />Dueling <br />_ <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />I <br />Other <br />I hereby codify that I have real and examined this appliCihon and know the same to be true and correcl All ixomons of hws and ordinances governing Illm type of work w7 be compLed <br />with whether specified herein or not. The granling of a permil does nor presume to grve aulhwlty to violate or cancel the provision of any other stall or local law regulating construction <br />l hat I am authorhed by Inc owner of M13 property to perform the work jai which application is made and t comply with the State Cunt: actors I.aw IB 77 RC W and 790 700A WAC <br />a2z: 9-is 266 /L <br />OwnerlAuthori¢od Agernt Signature Dale (Revised "013) <br />