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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS: _ <br />41'c <br />PROPERTY TAX # <br />PF-WAIT M <br />I 1 1 -i . - -C,(" <br />LEGAL for new construction Shod Platisubilmsion Lot No ..� (attach copy of long legal description) <br />OWNER FA12 EA-5 1' /—�) I-L- PP— c S A <br />Phone/E-mail S- 7 2 y c Y 4- <br />Address S 2 2- A-c 6.Ci2 v%/ +' Zz)L <br />CitylStatelzip 4 jy»o^-id S 6v4 9�l02 u <br />CONTRACTOR 12061n/SOn/ PL ✓ M/3 /n/C• f r- <br />L 8 1 Lic. # A2 0 3i^�' P AF -2- -7L-rr L <br />Address ^�)L A AC C 'h' "'r0^1 Phone/Email 26 U - y0 3 .7v(. L <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT /Zc�1 FZO$y..Jso. • 6' bnrS uE <br />C <br />PhonelE-mail 36u-yo- <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK Irz E' 0 C. <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building 5 FyC' Gas_ Electric_ Other_ <br />Building type: _Single Family _ Dupiex _Townhouse —Multi-Family _Commercial <br />Type of project: _ New _ Addition _ Remodel _ 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 _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn _Alteration _Repair <br />Type of Project: _New_Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />AIC - air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas pipmq <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (servicelbar/mopletc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinkin Founlam <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />nucting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other <br />2 O Number of Heads <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming <br />this type of work wit be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate of 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 property <br />to perform the work for WV,capplication is made and I comply win the Slate Contractors Law 18.27 RCW and 296 200 WAC <br />Date (Revised ?/'011) <br />owned�dzed Agent Signature ' <br />( 1, <br />