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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 />TIONS ARE ACCEPTED FROM 8 AM TO 4 PM a —/2 <br />APPLICA <br />SITE ADDRESS: <br />PROPERTY TAX If <br />PERMIT _ <br />t <br />�6) e- wA. - Z0 <br />LEGAL for new construction: Short Plat1subdivision Lot No._ (attach copy of long legal description) <br />OWNER Z-JkN 61rw C, <br />Phone/E-mail 0D <br />Address 2Z 164 M 'IT w.> rytwo-'�,I "'4' ) v.l <br />q <br />City/State/ZiP n.dnu-� L��• ! US <br />APPLICANT:.A.Owner _Owner's Agent _Contractor _ Contractors Agent _Tenant (mustpro„aealurcrmcanxmeommeo..rern dovevkmmespaca) <br />L & I Lic. # COE Bus. Lic. # <br />CONTRACTOR h <br />Phone/Email <br />Address <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMMIT <br />Phone/E-mail ( 4201 213 - 1 1 0 C� <br />PRICE OF WORK .L <br />BUILDING PERMIT APPLICATION ICONTRACT <br />HEAT SOURCE: <br />UUuI <br />Existing Use of Building - <br />Proposed Use of Building _ Gas_ Electric_ _ __ Other_ <br />Building type: � Single Family _ Duplex —Townhouse _ Multi -Family _ Commercial <br />Type of project: New _ Addition Remodel _ Repair T.I. _ Sign _ ..Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: 2CNew_Addn _Alteration_Repair <br />Type of Project: _New_Addn _Alteration_Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas ipin <br />g$ <br />Lavato (washbasirp <br />Water heater <br />Shower <br />replace <br />Kitchen sink & disposal <br />range <br />Dishwasher <br />s dryer <br />Clothes washer <br />hood <br />Water heater <br />st fan <br />Sink servicelbar/mop/etc.) <br />Imp <br />Backflow preventer <br />eater <br />Wuucbn <br />Urinal <br />Drinkin Fountain <br />eration <br />Floor drain <br />stove <br />Grease trap <br />Roof drains <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby Minty mat I have read and examined this applicaben and knew We same to be true and correct. All provisions of laws and ordinances govemirig this type of work will be complied <br />with whether specified herein or nol. The granting of a permit does net presume to give authority to violate or cancel the provision of any other state or local law regulalvtg construction <br />That I am authorized by the owner of this property to perform he work for which application is made and I comply with the Slate Contractors Law to 21 RCW and 296.200A WAC <br />lb ma <br />Owner/Authorized Agent Signature Date <br />(Revised 67012) <br />