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JUN U Z <br />PERMIT APPLICATION �pp������� <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLEPJDEMOLWTl&k)RKS <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everetwa.org U <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM I —I / —11 <br />SITE ADDRESS: 3zo� - A J� v. (`f <br />/Y Fi <br />PROPERTY TAX # <br />PE ITN / <br />LEGAL for new construction Short PlaUsubdiivision Lot No._ (attach copy of long legal description) <br />OWNER t" \C- <br />Phone/E-mail <br />Address 1N0 3 /� <br />City/State2ip ril gt-,/ W` A 9 ` <br />CONTRACTOR > • 41 t �( rt� � <br />L 8 I Lic. N C A ?-5 -rS A" D 1 4 <br />�C <br />y t��S �] ,y <br />3t1� Acj �-(i / PhonJEmail �9360c tASr 9 0 <br />Address - 1'() rl(ob late <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />k� <br />� <br />mail Phor IJ, (' Tlz Aet 36D -/93 , (O" b <br />BUILDING PERMIT APPLICATION ICONTRACT <br />PRICE OF WORK <br />Existing Use of Building <br />HEAT SOURCE, <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): 'jj C 1� D lc� S ` ` e-t 4 <br />_NO <br />Have you started working without a permit? _YES <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn —Alteration __Repair <br />Type of Project: _New_Addn —Alteration _Repair <br />Show Number (N) of fixtures <br />show Number (0) of fixtures <br />A/C - air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas pipirg <br />I Lavatory (wash basin) <br />Water healer <br />I Shower <br />Gas fireplace <br />Kitchen sink e, disposal <br />Gas range <br />Dishwasher <br />I Clothes dryer <br />I Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />I Sink (service/bar/mop/etc.) <br />Heal pump <br />I Backflow preventer <br />Unit healer <br />Urinal <br />j Boiler <br />Drinking Fountain <br />Refrigeration <br />I Floor drain <br />Woodslove <br />Grease trap <br />Ducting <br />I Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />i Number of Heads <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing <br />this type of work will be complied with whether specified herein or not. The granting of a peril does not presume to give authority to violate or cancel <br />the provision of any other state or local law regulating construction or the performance of construction. That I am authorized by the o+mer of this property <br />to perform the work for ��plication .5 mada a comply with the State Contractors ctors Law 18.27 RCW and 296 200 WAC <br />, <br />Owner/Authorized Agent Signature Date (Revised 212011) <br />�-.WrI <br />