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PERMIT APPLICAT�ON <br /> BUILDIN�/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Eveiett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �T`����`�, <br /> SITEADDRESS: � ZQ�) �J ��Q �D ���y PROPERTYTAXp PERMIT _ <br /> 4 !1 J <br /> LEGAL fo!new constmction' Shoit PlaVsu6Uivision Lol No._ (attach copy ol long legal description) <br /> OWNER L O I �, L �, �, Phone/E-mail � � <br /> Address r � � � G - �O �Q_ Cily/Slate/Zip � � � O <br /> CONTRACTOR `J f� � �� 1JC. ' L&� Lic.# K� I � <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> J �,A G e �J� � PhonelE-mail <br /> BUILDING PERMIT A PLICATION CONTRACT PRICE OF WORK <br /> l:xis�ing Use of Building Gv M. , • / pC/� HEAT SOURCE: <br /> Proposed Use o(8uilding � `�M � n� A�•�V� Gas� Electric_ Other_ <br /> Building type: _Single Family _Cui?lex_Townhouse _Multi•Family �,Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.i._Sign_ Sprinkler_Demolition_Change of Use <br /> DesCfiption of Work(addifional space provided on fhe back): <br /> Have you started workfng without a permit7 _YES � NO <br /> MECHANI�AL PERMIT APPLICAI'ION PLUMBING PERMIT APPLICATION <br /> Typu of ProJect: _Now_Addn _Altcration_Repalr Type of ProJect: _New_Addn _Alteretion_Repair <br /> Show Number(#)ol/ixtures Show Number(N)o/flxfures <br /> A/C-air handling units Toile� <br /> Forced air systems Bathtub <br /> Gas piping � Lavatory(wash basin) <br /> � Waterhealer � Shower <br /> � Gas fireplace I Kitchen sink&disposal <br /> Gas range Dishwasher <br /> � Clothes dryer _ � Clothes washer <br /> � Range hc�d � Water heater <br /> � _`xhaust fan � Sink(servicelbadmop/etc.) <br /> � Hea�pump � 8ackflow preventer <br /> � Unil heater � Urinal <br /> � Boiler _ Drinking Fountain <br /> Re(rigeration ' Floor drain <br /> � Woodstove � Grease trap <br /> � Ducting Rootdreins _ <br /> � Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> � Number of Heads I Other: <br /> I hereby certity ihal I have read end examined this application and know lhe same lo be lrue and corcect.All pmvisions of iaws and ordinances governing <br /> ti9s rype of work will be complied�sith whelher specified herein or nol.Tha granling of a permit does not presume to give aulhority lo violate or cancel <br /> Ine Hrovisinn of any other state o•local law regulating conslruclion ot ihe peAormance ol conslruction.Thal I am aulhorized by itie owner of this property <br /> to penc�m ih�vmrk r which application is made and I curnply w:th ihe Stale Conirac!ors Law 1827 RCW and 296200 WAC <br /> ' ��s'��/� �`-� � %�� --j/ <br /> 'T ' Date (Rc�isetl2/2077) <br /> OwnerlAuthorized ger.t Signaluro <br />