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�ERMIT APPLICATI� <br /> BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY' OF EVEf2ETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 Q25-257-8810 FAX 425-257-8857 www.everetlwa.org <br /> 5 — �7 ��Jc- <br /> SITE AD�RESS:�,� I � ^ � L� (�T PROPERTY 7N(k PERMIT p <br /> /� J / �� <br /> LEGAL for new conslruction: Short PlaVsubdwision Lot No._ (atlach copy of long legal descnption) <br /> OWNER /Z , f�'1 � � �� PhonelE-mad <br /> AtlOmss Z r� �"V� �I (J � Cityl51ale/Z�p L•�(„��'(.C7) <br /> APPLICANT:_Owner _Ov+ner'sAgent Canlractor _ContracloisAgenl _Tenanl�mo:iP�o.�a�oi:n��ciwnsomimmmew*,er.oaowon��,nmespa�e) <br /> CONTRACTOR 21" d'✓ /�l 1 �M MJ � State Lic. # �RI C6�� � I� ���iiY t3us. Lic. i! l/'1 1� <br /> A�'� PhonclEmail �C' " 7�`J��^" <br /> Address O� MM t✓LC��-' �' r�7� I I� � � <br /> CONTACT FOR PERMIT <br /> Phone/E•mail <br /> BUILDING PERMIT APPLICATION CONTRAC7 PRICE OF WORK_ <br /> �' �/) HEAT SOURCE�. <br /> Exis:ing Use of Building �i� f� . <br /> Proposed Use of Building cas_ eiectnc_ otner__ <br /> Building type:�Sinyle Family _Duplex_Townhouse _Mul�i-Family _Commercial <br /> Type of projecC New _Addition _Remodel _Repair_T.I _Sign_Sprinkler__Demolilion_Change of Use <br /> DESCRIPTION OF WORK(addd�ona�space provided on the back/: � <br /> MECNAMICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Project: _New_Adtl�. _Alteration_Repair Type of ProjecL _New_Addn _Alteration_Repair <br /> Show Number(N)ol/iztures Show Num6c�(k)o/(xfurrs <br /> A!C—air hantlling unds Toilet <br /> Forced air syslerrs Bathtub <br /> Gas piping Lavalory(wash basin) <br /> Water healer Shower <br /> Gas fireplace Kitchen sink S disposal <br /> Gasrange Dishwasher <br /> CloUies drycr Clothes washer <br /> Range hood VJ�ter healer <br /> Exhausl fan SiN� (servicelbar/mop/etc.) <br /> Hea�pump Oac,�Bo�v preventer(inside bldg) <br /> Unit heatcr Unnal <br /> Cioiler Drinking Founlain <br /> Retrigeration Floor drain <br /> Woc:lstove Grease trap <br /> � Ductin: Roof drams <br /> Other Medical Gas <br /> SPRINKLER I SUP�RE"sS10N SYSTEM Olher. <br /> Number of Heads Olher: <br /> I AereDy cen�ly Nal I�ave read ar.a eaamined lhis a ' �lon ana know Ine same to�e tmr antl corrcct.A!I provi�ions ol laws and or0inances govermng tnis Iype of work will�e compLetl <br /> wi1A w�elher specifed nol.l�e 9mnlin ol a perm does nol presume lo give aulhonly to violaie or<ancel l�e provision ol any olhe�slale oi local law re7ulating conslm[i�on <br /> T�al l am aut by I wner al l�is pmD y to peAorm �e work lor wnicn appl:wiion iz made and I eomply wuh ihe Slate Cantmclors Law 18 27 RCW and 296.2DOA WAC. <br /> . 1 Z6�a.� <br /> Owncr/Auth rizetl Agent Signalure Datc (Revised�t/1015) <br />