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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-IIa10— FAX 425-257-8857—�nnwv.everettwa.org / <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - 9/O —IS <br /> SITE �DDRE � � , /� U� PROPERTYTAXN PERMIT <br /> �J � � O <br /> LEGAL for nevrconstruuion: Short PlaUsu6tlivision Lol No._ (a(I�ch copyof long legal descrip(on) <br /> OWNER s �2, �QI� (���f�j4�.. �� �-G?.r PF.one/E�mzil �' 7i)- �' �J7' 7�� <br /> Address � 0 �(� �"�,�^ � /� Ci1y/St?te/Lip (��(fC� <br /> CONTRACTOR C.�/L'I'�-Et"� '�?�AIG St*LZi(M�Tr�Li L81Lic. # ��/E(�.�,�'iS�220j L(�i!' Vu"Iyy>' <br /> nderess Zl'� �C.I�L AUc il��`frG/4Q�h1o1 PhanMEma�l `�Zy-2�2-3iey� <br /> TENANT BUSINESS NAh1E CONTACi,FQ[i P�E,RMIT <br /> ��� vf �I`�`-' /VjAl�l�(� r�r�A.Gn- <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CON7RACT PRICE OF WORK � <br />� Existin9 Use of Buildin9��T�- . HEAT SOURCE: <br /> Proposed Use o!Buildir.g �� C��� Gas_x Elerric Other_ ._ <br /> Building lype: _Singie Pamlly _Ouplex_Townhouse _Ivlulti-F2mity �C Commerial <br /> Type of projecL _New _Addition _Remodel k Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Descfip�ion of Work(addifonal spacepmvidedon fhe backJ: <br /> ��R �175r�� µ,,,tT o�l`� <br /> Have you started working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION pLUMBING PERMIT APPLICATION <br /> Type of Projecl: _New_Addn _Alleralian#Repair Type of ProJecl: _Nev/_A'ddn _Alteralion_Repair <br /> Shov Nuniber(.".)o/Iir(ures Shaw Numhcr(4)ollix(ures <br /> � A/C-airhandlingunits � Toilet <br /> � Fercedairsystems � Balhlub <br /> � Gas piping Lavatory(wash basin) <br /> N/alerheater � Shmver <br /> Gas fireplace � I<itchen sink G disposal <br /> � Gas ran9e Dishwasher <br /> � Clothes dryer � Clolhes washer .. <br /> � Range hood � Water heaier <br /> � 6xhaust tan � Sink(servicelhadmopletc.) <br /> Heat Uump � Backflo�v preve�ter <br /> Unitheafer � Uiinal <br /> � �oiler � Drinkinq Founlain <br /> � Refri9eralion � Floor drain <br /> � Woo�stove � Giaase trap <br /> Uucling � Rcofd�ains <br /> � � O�tier I i�ledical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM I o�hcr: <br /> INumberof Heads I Olhec <br /> I hereby cendy thal I have read and examineJ ihis appiicalion anA know Ihe same l0 6e frue and correcl.All provisions cl iavis and erdinances�ovendn9 <br /> Ihis type o(�vark�•nll be complieJ vnlh vAielhcr specifed hertin or not.The granling of a permit does no�presume�o give authorily to violate or cancel <br /> �he pmvision o(any olher slale or lucal law regulating conslruclion or�he pedormance of cons�mUiort Thaf I am aWhorizeJ by Ihe oa•ner of ihis property <br /> lo perform the work lar which applicaiion is made and I comply w;Ih O�e State Contactors La�v 18.27 RCN/and 296.200 WAC <br /> �D2 �' � �,:�:� . <br /> OwnedAulhorizc nt Signature �' Date �� evi ed 2/2011J <br /> , ,,...r. . ��z <br />