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PERMIT APPLICATIA <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.evereltwa.org <br />(I-S-1 S <br />SITE ADDRESS: <br />l OG it ini 4 <br />PROIii TAX # <br />PER I <br />_ O <br />LEGAL for new construction. Short PlaUsubdivision Lot No (attach copy of ibng legal description) <br />OWNER T)A,1,i <br />Phone/E-mail H25--7(,O-P3N(e' 5ho1d1'7(Q5r1nA,1 Celt, <br />Address 19L)U <br />Cdy/Stale/Zip I�,i 1-r <br />APPLICANT: —Owner _Owner's Agent ,J_Contractpr _Contractor's Agent _Tenant lmoa vroHao. beer al cansennmm mo onn to op won In me space) <br />CONTRACTOR CJ 1-I Er4ThJU (,l_C <br />State Lic. # CJ F1EA J N 883J J City Bus. Lic. #4l74)lild PL- <br />C S I <br />Address o LJ rrJ T)SW ♦7l— JF ROn �Ar 9tO5la Phone/Email q2,>- qqy-26eZ <br />$7 <br />T BUSINESS NAME <br />CONTACT FOR PERMIT <br />Phone/E-mail 'y ZS— 4qf-/— Z(,sZ JrM)V,n C/ (Z % o&4a,7. r <br />1.;ONTRACT <br />BUILDING PERMIT APPLICATION PRICE OF WORK <br />Existing Use of Building_-- HEAT SOURCE - <br />Proposed Use of Building —Gas_ Electric_ Olher_ <br />Building type: I Single Family _ Dupl jx _Townhouse _ Multi -Family _ Commercial <br />Type of project. _ New _ Addition V Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional spacepmwdedon the back)' <br />12�P1°u 6Id r),s r,a;-tr- .Lew <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project! _New _Addn X Alteration _Repair <br />Show Number (#) of fixtures <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Numbertrill) or fixtures <br />L - air handling units <br />Toilet _ <br />Forced air systems <br />_ <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Dishwasher <br />Gasrange <br />Clothes dryer <br />Clothes washer <br />Range hnod <br />Water healer _ <br />Exhaust fan <br />Sink <br />(service/bar/mop/etc. <br />Heat pump <br />Backflow <br />preventer (inside Clog) <br />_ <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor chain <br />Woodsfove <br />Grease trap <br />Ducting <br />_ <br />Roof drains - <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of 1-'eads <br />Other: <br />I hereby terrify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work Val be complied <br />wile whether rpecifed herein or nor The granting of a permit does not presume to give aulhonfy to violate or cancel the provision of any other stale or local lew regulating construction <br />That I am authorised by the owner of this property to perform the work for which application is made and I comply swth the Stale Contractors Law 16.27 RCW and 296.200A WAC. <br />O n rlAuthorized Agent Signature Date (Revised 4120151 <br />n-, <br />