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PERMIT APPLICATION <br /> BUILDINGIMECHAIVICALIPLUMBINGISIGN/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 <br /> SITEADDRESS: % PROPERTYTAXp PE ITA _!'�. <br /> n J -� � GC� SS 6oc aoo �oo � <br /> 43� l`IGII�. O"� .VFZ.i <br /> LEGAL for new construction: Shod PIaV=.uhJivision Lot No._ (altach copy of long legal descriplion) <br /> -I V N�t�� 1 Phone/E-mail f��2 '(�OM <br /> OWNER �n��eS `�i -�cnu�+,� EG clerr,e rZCK <br /> Address <br /> ?` .,.��vi�- _VfL, CitylSla�elZiP C�7c'2.. �A. <br /> CONTRACTOR SE'-I F L 8 I Lic.# <br /> PhonelEmail <br /> Address <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �„L PJN �� �Jt i ZSZ'`{01 S <br /> PhonelE-mail �"e n o t1 R.. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK nl� Can�.r�� "}' <br /> Existing Use of Building J�f n-'r i � -i1��— HEAT SOURC[: <br /> Proposed Use of Building '�t�R.nG� r�9� Gas� E �ctric_ Otner_ <br /> Buildingtype: �SingleFamil _Duplex_Townhouse _Multi•Family _Commercial PRo�esrc�.�� N�N� <br /> Type of project: New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use ` <br /> Desc�iplion of Work(addifional space p/ovided on the beck); _ _n7� �{,�9 �jp � S�oi�ao�L p� ��4z � E7US�wJ ?�P-, <br /> �— <br /> ( < « <br /> � Uf.l�p7F6{ F�O�J� I�A�I�1/}R� S1oQAGE ,4RL�A. <br /> Have you started working w'thout a permit7 �YES _NO <br /> MECHANICA PERMIT APP PLUMBING PERMIT APPLICATION <br /> Typo ot Projecl: _Nuw_Addn _Altaratlon_Rupair Typo ol Pro�cct: _Now_Addn _Alteratio�_Rapair <br /> Show Number(N)ollixfures Show Number(M)o/fixfures <br /> � A/C-air handling unils � Toilel <br /> Forced air syslems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Waler heater Shower <br /> Gas(ireplace Kitchen sink&disposal <br /> Gas renge � Dishwasher <br /> Clothes dryer Cbthes washer <br /> Range hood Water heater <br /> Exhausl�an Sink(service/bar/mop/etc.) <br /> Heat pump � Backflow preventer <br /> Unit healer I Urinal <br /> Boiler Drinkin Founlain <br /> Refrigeralion Floor drain <br /> Woodslove Grease trap <br /> Ducting Roo(drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> � Number of Heads I Other: <br /> I hereby certify Ihat I have read and eaamined ihis application and know tho same lo be Irue and wrrecl.All provisions ol laws and ordinances goveming <br /> Ihis type ol work will be complied with whelher specifed her in or not.Tho granling of a permit does nol presume Io give authority to violate or cancel <br /> Ihe provision ol any other state or�ocal///la���w regulaling c r ction or ihe pedormance of conslmctioa 7ha1 I am authorized by Ihe owner of Ihis properly <br /> to pedoim Ihe �k lor�vhich applica1yop55 made nd I o p wilh Ihe Slate Contractors La�v 1B.27 RCW and 296.200 W4C <br /> ;'�'�/y� � / � � it},� � <br /> 7zT . r '�� r �U + Z <br /> Own6r/Authorized Agont Signaturo 1 Oale (Revised 22071) <br />