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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everelt,WA 98201 -425-257-8810—FAX 42.5-257-8657—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> PROPERTY TAX M PERMIT N <br /> SITEADDRESSf �„� �� '1 • (�y 3lCC ji,'„ C�' �O� - U� <br /> p ,o E=1 rlr � . ��� �i , <br /> LEGALIornewconsiruction: St+oAPlaUsubdivision — <br /> Lot No._ (altach copy o��ong legal descnptfon) <br /> owNeR 17�iU�-1�Z - =a—, c�� � �'��� � Phone/E-mail 'il� -4/I-J37� <br /> �ddmss "C �; �C< 2' ��TI� <br /> CitYlStale'Zip ty1'x.e�'� �•� '')'���j <br /> CONTRACTOR 'iE1 ' L 8 I Lic.# <br /> PhonelEmail <br /> Atl4re55 <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION <br /> CONTRACT PRICE OF WORK S�� `� 'a� <br /> � HEATSOURCE: <br /> F�cisting Use of 6uiiding �+h " �' � '"'�' " <br /> Gas_ Etecitic_ Other_ <br /> Proposed Use of Buildina S {�^�t— — <br /> Duildingtype: _SingleFamily _Duplex,_Townhouse _Multi-Family _Commercial <br /> Typeofprojer!: _Nea _Addilion _Remodel _Repair_T.L_Sign_Sprinkler_Oemolilion_Change oNse <br /> Descriplion of Work(adtli(ional:oace providetl on Ihe bacN): S/� �_ ` ! �� ,��J�= <br /> ✓su�[ � t s°>v.^v siia� •a•�r��,�rn -r� Sw, <br /> Havo you s�arted working wilhoul a permil7 _Y[S �[JO <br /> MECHANICAL PERMIT APPLICATION PLUM8ING PERMIT APPLICATIdN <br /> 7ypeolProJect _New_AdAn _A��cr.tlon_Repalr TypeofPro�ecC _New_Adtln _Alleratlon_Repalr <br /> Show Num6er(�)o!I/xtures <br /> ShowNumber(M)oflisfures Toile� _ <br /> � yC-airhandlin9unils � I3alhtub <br /> Porced air syslems Lavato (wash basin) _ <br /> � Gae pipin � Shower <br /> � Water heater I <br /> � Gas firealace Kilchen sink&disposal <br /> Gas range � Dishwasher <br /> Clolhes dryer � Clothes washer <br /> � Range hood � Water heater <br /> � Exhaust fan � Sink(service'badmo /etc. <br /> Heat pump � Backllow reventer <br /> Unit healer <br /> Urinal <br /> Drinkin Founlain <br /> Ooiler I <br /> Floor drain <br /> � Refrigeralion Grease tra <br /> � Woodstove <br /> Roof drains <br /> � Ductin Medical Gas <br /> � Other I <br /> SPRINKLER 1 SUPPRESSION SYSTEM Other: <br /> I Num6er of lieads I Other: <br /> I hereby cedify that I hare reatl antl examined Ihis applicalion and knew the same lo be Irue and wrtect.All pmvisions ol iaws and ordinances goveming <br /> ihls typo cf work wJl U:compiied v.^�Ih�ehelher specified herein or not.The granling ol a DermA does net p�esume to give authority lo violate cr cancel <br /> ihe provision ol any other stale or!ocal law regulaUng construction or Ihe pedermance ol mnsWqion.That I am authoneed by the o�+ner of lhis properry <br /> to p�rtorm tho wo�k fer eMich aODGcation Is matla and I comply with tho State Conlraclors Law 18.27 RCIh'and 298100 N'AC <br /> 7i <br /> � � L � �----� `7- I 7- /L- <br /> Dale (Revised L20f 1) <br /> OwnedAulhodzed A9ent Signature � <br /> � Z <br />