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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857—www.everpttwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: <br />'G'YIg lzvse Lt)no� <br />PROPERTY TAX It <br />ERMI i <br />_u -uIU <br />LEGAL for new construction: Short PlaUsu ar ivision Lot No._y (attach copy of long legal description) <br />OWNER j--; ig24S7 _ r� �f <br />Address <br />Phone/E-mail <br />City/Stale/Zip {-']�i)]„x.. S Ll. <br />CONTRACTOR �0.� J:>tin PL. ern/ ,.� <br />L & I Lic. if N % 7 2. e- 2— <br />Address 3 y-l3)j <! /)�f J7 yL rC,',L �Q/1C/x...4lZ!N ffione/Email (30c)) q0 3 '/y1,L <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />Phone/E mail ^d YO 3 7 V V IA- r-e x <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE' <br />Proposed Use of Building S F, Gas Electric_ Other_ <br />Building type: Single Family _Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project: _✓New — _ Addition _ Remodel _ Repair_ T.I. _ Sign ✓Sprinkler_Demollrion_Change of Use <br />Description of Work (additional space provided on the back): <br />/A)Si4II- F/2K /. ,vL`7� SriL l�0/1c-R-JS� <br />Have you started working without a permit? _YES li NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (N) of Fixtures <br />Type of Project: _Now_Addn _Alteration _Repair <br />Show Number(R) or Fixtures <br />_ <br />NC- air handling units <br />Toilet <br />Forced an systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />_ <br />Clothes dryer <br />Clothes washer <br />_ <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backtlow preventer <br />Unit heater <br />Urinal <br />_ <br />Boiler <br />Drinking Fountain <br />_ <br />Refrigeration <br />Flocrdmin <br />Woodstove <br />Grease Imp <br />Ducting <br />_ <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER if SUPPKESSION SYSTEM <br />_ <br />Other <br />2- . Number of Heads <br />I hereby certify that 1 have read and examined this application and know the same to be hue and correct. All provisions of laws and ordinances governing <br />this type of work will be complied with whether specified herein or not. The granting of a pennil does not presume to give authority to violate or cancal <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 property <br />to perform Ibe work for w llal application " Fade and I comply with the State Contractors Law 18.27 RCW and 200.200 WAG <br />OwnerlAutriorizetl Agent Signature ItDate (Revised 122010) <br />112 <br />