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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 />11"I 33r't A�e.nite Cvt 91-Lo-3 <br />PROPERTY TAxa <br />OOS'Il-7oo of 300 <br />PERMIT a <br />7nq a <br />LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br />OWNER ScAt pad Tune Nod%, 77 <br />Phone/E-mail 42S'- 341- 3743 <br />Address 4914 33"d oenlne, W <br />Cdylstatelzip Gvetc;{f 4Z7-p3 <br />APPLICANT: —Omer )LOwners Agent _Contractor Contractors Agent _ Tenant(muttprcvrceek!terol nsenlnom mco,.nn to dovox:n me soul <br />CONTRACTOR TO-�fi <br />•e Q � . <br />L 8 1 Lic. # COE Bus. Lic. # <br />Address UMorlqJ5, W A . Phone/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />FerA 11 A ssoola+er <br />PhonefE-mail /17 s' - 3 4 g - 3`1-7 S <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK sl� I>�,mr� <br />Existing Use of Building Yrs (J-2# - is ( HEAT SOURCE. <br />Proposed Use of Building Yts lay.41a Gas_ Electric)< Other_ <br />Building type: Lc Single Family _ Duplex _Townhousu _ Multi -Family _ Commercial <br />T pe of ro'ect New X Addition A Remodel Repair T.I. Sin _Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />j)e.rr,ol j5{l eY ISHAnI5,314 9prace . <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Tyoe of Project: _New_Addn Alteration _Repair <br />Show Number (a) of fixtures <br />Type of Project: _ New_Addn Alteration _Repair <br />Show Number (a) of fixtures <br />I AIC - air handling units <br />I Toilet <br />I Forced air systems <br />j Bathtub <br />_ <br />Gas piping <br />Lavatory (wash basin) <br />I Water heater <br />Shower <br />Gas fireplace <br />i Kitchen sink 8 disposal <br />I Gas range <br />Dishwasher <br />I Clothes dryer <br />_L <br />Clothes washer <br />I Range hood <br />I Water heater <br />I Exhaust fan <br />i Sink (service/barlmo /etc.) <br />I Heat pump <br />! BackBow preventer <br />Unit heater <br />I Urinal <br />I Boller <br />I Drinking Fountain <br />I Refrigeration <br />I Floor drain <br />( Woodstove <br />I Grease Irap <br />I Ducting <br />I Roof drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />i Other <br />Number of Heads <br />Other: <br />I hereby censly that I have read and examined this appbcation and know the same to be true and W nect All Prosasxins of laws and ordinances governing Ibis type of work vA be complied <br />wpnwhetherspechedhereinornot The grantmg of a purmd does not presume to give authomy, to violate or cancel the ptNtscri of any oh-t state or lout law regulating construction <br />That I am author by the owner of this property to perform the work far Wmen application is made and 1 comply wth the State Contractors taw 19.27 R(.W and 296.20DA WAC <br />7 <br />'9-, '/ •l3 v <br />O er' ulhora Agent Sig e Datn (Revised 612012) <br />