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PERMIT APPLICATION <br />BUILDING;°dECHANICAL/PLUMBING(SIGN/SPRINKLERIDEMOLMON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 —FAX 425-257-8857 — v/ww.everettmorg <br />woe AICEPTED FROM A AM TO d PM <br />11 j APPLICATION. A.— PROPERTY TAXI RMIT# <br />SI? A�DLD ESS: 14,0 WOIA^ti A 4e, 0 a. (�2S-Uon C7 <br />LEGAL for new construction: Short PlaUsubdiviisiioon AN % _ No.! 7tta copy of long legal description) <br />01A .z5 .4b 1 1' <br />14e4+PhonelE-mail Gv1%�I (� <br />OWNER /a-yr�G� �JWIG1. <br />City/Statelrp vr�P.i�V'fi vir:A rid <br />Address GV f <br />-7� <br />�17Kpw 1 L & I Lic. # IT-1 PTO ON <br />CONTRACTOR ( raj <br />/)�/ �L �t ,( CAM QI .r r/2 O <br />Address bICI � C' P A-Y ✓! •vr1 4 !� J Phone/ mail�471 NvtoN qB� <br />/ <br />TENANT BUSINESS NAME CONTcos <br />ACT FOR PERMIT 41 r A <br />h r I.tJ • <br />1 <br />PhcnefE-mail �(p. �I. e'�,S tN llv.�.w�i-�h"rt• <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />1 HEAT SOURCE: <br />Existing Use of Building i <br />I /7aN (M�1I Gasx Electric_ Other_ <br />Proposed Use of Building -- <br />Building type: _: Single Family Duplex Townhouse _Mull( -Family _Commercial _ <br />Type of project: Remodel _Repair_T.I._Sign_,Sprinkler_Demolition_Chaange of Use <br />_New ,Addition <br />1 <br />Description of Work(addilonal sp ce provided on the back): !, I�'f r�-e�l�i{"-t O' ✓K'f"r`'1^��"�a <br />pc�°Je�� t3cg�` `r�lrr�rr F <br />r <br />h��'n'v'V �,cr+�xK TciSh (t hIF ZNJ..CIoo e 0'.A ,-�t'�wcc urj fle�1.V. <br />f; L2-!is r <br />Have you started working without a permit? _YES 7�N0 " 6 ..e,rc <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIC TIO �" <br />L <br />Typo of Project: _Alteration __Repair <br />Type of Project: _New_Addn __Alteration —Repair <br />_New_Addn <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />I Toilet <br />A/C- air handling units <br />I <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />I Gas pi in <br />Water heater <br />I <br />Shower <br />Gas fireplace <br />I <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />! <br />I Range hood <br />I Water heater <br />I Sirk (servicelbarimop/etc.) <br />Exhaust fan <br />HUneat pump <br />I Back,low prevenler <br />it heater <br />I Urinal <br />I Drumm Fountain <br />Boiler <br />Refrigeration <br />I Floor drain _ <br />I Woodstove <br />I Grease trap <br />Ductin2 <br />I Roof drains <br />Other <br />Medical Gas <br />SPRINKLER! SUPPRESSION SYSTEM <br />I Other: <br />Number of Heads <br />Other: <br />I hereby certify that 1 have read and <br />this typo vrork wny com iI, <br />the pro is' n of any t r s too Ic <br />to pe mho work ,hl h ap Ic <br />application and knew the same to be true aiid correct. All provisions of laws and ordinances governing <br />xifed herein or not. The granting of a permit does not presume :o give authority to violate or cancel <br />ling construction or the performance of construction. That I ani authorized by the owner of this property <br />and I comply with the State Contractors Law 19.27 RCW and 290.200 WAC <br />11 <br />�.(c,2012 <br />Dato (Revised 212011) <br />K2 <br />