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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERET7 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 MITJt <br /> / �� S 1-t��,�_ t- � r--�_�r_- z�1nSi � .m�� 53nn IZO - �:ti <br /> LEGAL for new construction: Short PlaVsubdivision Lot No._ (altach copy ol long Iegal tlescnption) <br /> OWNER �1..17.-/R V,�T �� /�('7 ���•��' FhonelE-mail �LS -�) J l -�j )4 j .�L C U t4) . P(j� <br /> v <br /> Address ( UJ'i _G[.-1�,�� Cily/State/Zip ��i,L� �✓�(}- U Zp <br /> APPLICANT: Ownr.r _Ownei'sAgent __Conlraetar ConlractorsAgeni _Tenan��m�sipmraeaiar.erc�consernirominoo+nerioao.o«mmaspacel <br /> CONTRACTOR f�J /�c-- L 8 I Lic. # COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exis�ing U.,.:of Buildiny �'-h N-r'��' i�fi _ HEAT SOURCE: <br /> i <br /> Proposed Use of Building �_ 1 /�/L Gas_ Electnc_ Other_ <br /> Building type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial � <br /> T pe ot project: New Addilion Remodel Repair_T.I._Sign_Sprinkler✓ Demolition Chan e of Use <br /> DESCRIPTION OF WORK(add�(icnal space prov�ded on the back): <br /> C> .---r-� �; �� ': � �- 't�. �-�{'� /' ✓`.� �Y i �:�-f� rJ ��-- r-� �-�'�' �-�. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Pro)ect: _New_Addn _Alteration_Repair Typo of Projecl: _New_Addn _Alturauon_Repair <br /> Show Numbcr(p)ol lixmres Show Number�p)ol lizmres <br /> I AiC-air handling units ' Toilet <br /> � Forced air systems ' Bathtub <br /> I Gas piping � Lavatory(wash basin) <br /> ' Water heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br />� Gas range ' Dishwasher <br /> I Clothes dryer Ctothes washer <br /> Range hood � Water heater <br /> Exhaust fan I Sin4;(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> � Umt heater Urinal <br /> ! �o�ler �' Drinking Fountain <br /> ' Refrigeration I Floordrein <br /> Woodstove ! Grease irap <br /> I Duding Roof drains <br /> � Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> Number of Heads � Other <br /> I herr.�y cemfy Ihal 1 have read and e�am�ned thn aVP!�wbon anA hne�,v Ihe same lo Ce true and correcl.All pmvisions ol laws an0 ord�nar,tes goveming Ihis type ol qvrk w�.11�e cempHetl <br /> �cdhµ�ether speu9eC�erein or nol.lhe gr,nP,r.g ol a permil Eoes not Fresumo lo glve aul�ority to vrola,e or wncel t�e provision ol any oIDer<.tate or lo<al law regulalir.g cons:rud�on <br /> l�al l ar�aulhotlmtl by the oxner ol ihis propetly lo perfomi I�e xrork for HTich apphcation is ma0e and I complyµ�il�n:State CONraclors Law 78 27 RCW anU 296.POOA WAC. <br /> y � � <br /> � J n' <br /> ,� � � � ' 1 �, � <br /> �/ ,� ` /' � <br /> ' '�//' 11.� �� i.) 'C. ' �^.'' �� �__ <br /> OwnorlAuthodzU�,Agont Sic�nature Dale �Fevised E/2072) <br /> ' �% <br />