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PERMIT APPLICATION <br />BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar S!., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ADD ESS: r / (� S , 1 <br />PROPERTY TAX <br />PE IT - I <br />,aaITE <br />LTEGAL for new construction. Shon Plat/subdivision Lot No._ (attach copy of long legal description) <br />OWNER 4((,ejJ PA711,0K. <br />Phone/E-mail <br />Address <br />City/State/Zip <br />APPLICANT: —Owner _Owner's Agent Contractor _ Contractor's Agent _Tenant must viohdeat,ter of wnsem hom mo cwn,r to eo wuiknm, :pac,i <br />CONTRACTOR /N1?Jv1 A"dyl? <br />State Lic. # l h - Z l y us. Lic.# , <br />qqY <br />Address Phone/Email Y 2 S ' %S� / _erl � 'f <br />TENANT 8 SI S NAME <br />CONTACT/r/E g,PERM� Ij <br />(/ <br />Phone/E-mail� <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building S f iZ HEAT SOURCE: <br />!� <br />Proposed Use of Building GasElectric_ _ Other_ ■ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project. _ New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolilion_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the q; c 1: AS <br />3o k�fo� <br />SP2/kifC��"e� r? <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New -_ Addn _Alteration _Repair <br />Type o1 Project: _Now _Addn _Alteration _Repair <br />Show Number fa) of fixtures <br />Show Number(#) of fixtures <br />A/C — air handling units <br />Toilet 1 <br />Bathlub <br />Forced air systems <br />Gas piping <br />Lavatory (wash basin) 1 <br />Water heater <br />Shower <br />Gieplace <br />Kitchen sink 8 disposal <br />.... _ <br />Gas range <br />Clothes dryer <br />Dishwasher <br />I Clothes washer <br />Range hood <br />I Water heater <br />Exhaust fan <br />I Sink (service/bar/mop/etc) 3 <br />Heal ,ump <br />I Backflow prevenler '1 <br />Urinal '1 <br />_ _ <br />Unit heater <br />Boiler <br />Drinking Fountain 1� <br />I <br />Refrigeration <br />I <br />Floor drain <br />Woodstove <br />I <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: I <br /># Number of Heads <br />i <br />Other: ° <br />I hereby cendy that I have read and examined this application and know the same to be true and wrred. All provisions of laws and ordinances goveming this type of work mul be complied <br />with whether specified herein or not. The granting of nnil does not presume to give authority to violate or cancel the provision of any oiher state or local law regulating wnsuudion <br />Trial I a onzed b e o r of this prop, moon the work for whit ppliwtion is made and I wmply, with the Stale Conlradors Law 18.27 RCW and 296.200A WAC. <br />wrier/Authorized Agent Signature ate (Revised 12013) <br />