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I r#ERMIT APPLICATION <br />BUILDING/MECHANICAUPLUMBING/SIGN/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 />APPI MATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Y c�a <br />SIT€ADDRESS: <br />'G 3c, {Lae KEFELLm AVE- <br />PROPERTY TAX N p�, �M <br />oa439 1 ��+ • 0► J ^— <br />PE IT2 <br />///-' - <br />LEGAL for new construpclion Shen Plat/subdivision Lot No (attach (attachh copy offllong legal descnption) ��, p-00 <br />OWNER FIRST" I R2E6 i 1Ew44 CdL" <br />Phone/E-mail 4'ZS-151'7i <br />Address 2 /.rip 9��F—pii �EdVE <br />13/IA 0.�f <br />City/State/Zip C—V � µA. 1bZ0I <br />CONTRACTOR +';IAT-E CD/F AS!;C6' LLG• <br />L & I Lic. # 1"I9-TLAL9SI S C- <br />Q <br />Address 10/0 5.E. EVFF-E.7TM,4U.l-JA (�7r%((' V gepg Phone/Email 42S'0001 C F0� <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT-T)cvn4S P.ii4UD KOM <br />PhonelE-mad 42S-ZS" 1'3I(cl -rm,(rA a DyA;9mgA'-UET <br />BUILDING PERMIT APPLICATION ICONTRACT <br />PRICE OF WORK <br />I <br />Existing Use of Building rah A4/W)77E5) HEAT SOURCE: <br />Proposed Use of Building CrtbJC�4 lar9 �d/G Actl�m Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family ,K- Commercial <br />Type of project: _ New _ Addition _ Remodel _'X_ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use . <br />Description of Work (additional space provided on the back) <br />Have you started working without a permit? _YES X NO <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) or fixtures <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Lavatory (wash basin <br />Shower <br />Kitchen sink & disposal <br />I Dishwasher <br />I Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backffow preventer <br />Urinal <br />Unit heater <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Woodslove <br />Floor drain <br />Giease trap <br />Ducting <br />Rcot drains <br />Other <br />Mental Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other <br />1 Number of Heads <br />Otner: <br />I hereby certify that I have read and examined this application and know the same to be Lve and correct All provisions of laws and ordinances goveming <br />this type of work will be complied with whether specified herein or not. The granting of a permit d ,es not presume to give authority to violate or cancel <br />the provision of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this properly <br />top the wo1K for whit pplication is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />J fJp,¢iL /5, Zo/ I <br />wnerlAuthorized Agent Signature Date (Rev,sed 2,2011) <br />t i V <br />