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PERMIT APPLICATI(�N <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320U Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www•everettwa.o/rg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I�-°�(�`�Z- <br /> PROPERTYTA%N PERMIT# / <br /> SITEADDRESS: '%' `" .'.1c:r.l I ��,-<:��- . �.. - - l <br /> �` °.9 D�i��:_0✓iOS�i�., <br /> LEGAL lor new conslruction: Shurt PlaVsubdivision Lot No._ (attach copy of long legal description) <br /> OWNER ��:�������r �I�r� i��� ��'� ?honelE-mail <br /> p•: <br /> Address 1�%>1 �' �"���^�i `�,� CirylStelelZip I,vc.2-m, L^%ik '1 �ZV4 <br /> APPLICANT:,_Ovmer _OvmersAgeN Conlraclor _CoNraclofsAgenl _Tenantlm�siop�beabnaroimou�u�mu,eowo�rmao.wanms:pa�i <br /> ^ L&I Lic.# F�'c.=�,','-�-��'��"� COE Bus. Lic.# J`I'� i�C� <br /> CONTRACTOR i��:,-:,:<<n I�.:�rT�..\�:; �':'.• <br /> Address I ;.�j S ,A�� ;/<n.,.., `� ��.'c�'.;�.�_ �A.���•� •�� c.l�' �, PhonelEmail vUG-7C;, - 1 j`-� `I <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ��� ^��� _ �-t��;; �_ � _�_y ; <br /> i,li l� ��;-'`�:,l�nrr <br /> , � i_ ,�:��;��„�„ '.�i..���-��.��.;1 PhonelE-mail �C�[f���C�nn�'e...lw-c.:.,.., <br /> BUILDING PERMIT APPLICATION <br /> CONTRACT PRICE OF WORK �' �'�' �`�'`� "' - <br /> HEAT SOURCE: <br /> Existing Use ot Building <br /> Gas Eleciric_ Other_ <br /> Proposed Use of Building — <br /> Building type: _Single Family _Duplez_Townhouse _Mulli-Family '�Commercial <br /> T pe o(pro'ect: _New Addilion Remodel _Repair_T.I. Si n_Sprinkler_Demolition_Chan e of Use <br /> DESCRIPTIONOFWORK(adddiona�spacopmvidedontneback/: ! (L , � � f'.�.,, <br /> -j:�;�< Ir. inle.,� ��� . . I, .> ,�-�. ,- ! :�. . . , .� i �' � 1 �, . „� . . . . .. � . : <br /> ,.'' h; ,.. - '-, ) - � � ` " . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ype ot ProJecl: _New_Addn �Alleratlon_Repalr Type of ProjecL• _New_Addn _AlteraHon_Repalr <br /> Show Numbcr(p1 0/fixtwes SM1ow Number(N)of Rxfures <br /> � � AIC-air handlin units Toilet <br /> Forced air syslems Balhtub <br /> '� Gas piping Lavalo (wash basin) <br /> Water heater � Shower <br /> ' Kilchen sink 8 disposal <br /> � Gas fireplace � Dishwasher <br /> �, Gasrange <br /> I Clothes d er Clothes washer <br /> Range hood Water heater <br /> �� Exhaust fan Sink(servicelbadmop/elc.) <br /> � Backflow preventer <br /> ;+_ ! Heat pump Urinai <br /> ' Unit healer . Drinkin Founlain <br /> Boiler <br /> ' Refri eralion Floordrain <br /> � Woodstove � Grease�rap <br /> Ducling ' Roof drains <br /> I; Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other. <br /> Number of Heads Other: <br /> I hem6y certAy lhall havo read nnd e�amined Ihis apPlicatbn and Anaw Ihe sema to ho We and torruct.All provabns ol Wws and ordinances goveming this rype olwork vnll he compbed <br /> with whether specd�ed herein or naL lho granhn�oi a De��does nol presuma lo grve eul�onry lo vblele or cancel the D���bn of eny other stata or bwl law regulating conslruction <br /> ihal l am aulho�zed by Ihe owner ol Nis proDerry to Dedoim tho work for whkh apPliwtbn I5 matla ana I camply wdh tha Stato Contractors Law 7827 RCW and 296.200A WAC. <br /> r � <br /> � . ��_ � : � <br /> . .'r�\ �1 ' � ' '- (Revised 6/2072J <br /> OwnedAu�horized Agent SlgnaWro Date <br />