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PERMIT APPLICATION <br /> BUILDING/MECHANiCALIPLUMBINGISIGN/SPRINKLERILIEMOLITION <br /> CITY OF EVERETT PERMIT SERVECES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.ever�e]ttwa.org <br /> APPLICATIONS ARE ACCEPT[D FROM 8 AM TO 4 PM 6 `-o�O�-1 Z <br /> SITEADDRESS: PROPERTYTAXtI P T# _��2 <br /> ao �LL- `WWr�' �w <br /> LEGAL for new conslruc�ion: Short PlaVsuhdivision Lol No._ (atlich copy of long Iee�al descnption) <br /> OWNER EM�I2l1U5 A� Sc�vu� fq,l.e., ������� 2'_ 333-3Zz <br /> n���r�ss �2�(0 4�' �`��' c�y�si��erziP EUGvitt7, UAa �iSZU <br /> CONTRACTOR LUEY�r�f11�� S �' � �b�� L&I Lic.# EUG14G5S o22�T <br /> 4 p 1 <br /> �ddress�7D t(��('.tG /�f/t� rC.vclQ-�'�T I.V� 7't/�� Phone/Email �ZS- 272' /��`f <br /> TENANT BUSINESS NAME CONTACT FOR PERMIi <br /> Phonc/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of�uilding_ �"ti/''�u' �' HEAT SOURCE: <br /> Propcaed Use o(Building_ 5�'� Gas__ Electdr.X Oiher_ <br /> Building lype: _Single Family _Duplek_Townhouse _Multi-Famiiy �_Commercial <br /> TypeofprojccC _New _Addition _P.emodel �Repair_T.I._Sign_Sprinkler_Demolition_Change ofUse <br /> Descriplion o(Work(additiupal sp2ce providerl on the backJ: � /. / � <br /> 2�1� �A'7(�/t�/llL R-�v wtYN L�k� W,�- 4kd w(�(°B3. DGct cvr•vlr, �J'(o •� u,�a <br /> (ZuoL Povrt�'ttQt'S� <br /> Have you started working without a permitl __YES �,NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProject: _New_Addn _Alteralion�Repalr TypeofProlect: _New_Addn _Alteratlon_Repair <br /> Sbow Nwn6er(q)o(/ixfares Show Num6er(pJ alliztures <br /> A/C-air handling units ' Toilet <br /> Poreed air syslems �athtub <br /> Gas piping Lavatory(wash basin) <br /> Waler heatar Shower <br /> Gas freplace � Kitchen sink&disposal <br /> � Gas range � Dishv�asher <br /> Clothes dryer Clothes washer <br /> � Range hood Watr,r heater <br /> Exhaust i2n � Sink(servicelb2rlmop/etcJ <br /> Heat pump BackOow preventer <br /> � Unif healer Urinal <br /> 8oiler Drinking Fountain <br /> Refrigeralion Floor drain <br /> Woodstove Grease lrap <br /> Ducting Roof drains <br /> � O�her _ Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM I O�her: <br /> � Numberof Heada I Other. <br /> I hereby c^_rti(y ihat I have read and ernmined Ihis application and know the some tn be tme anJ correct.All pmvisions of latvs and ordinances governin� <br /> Ihis type of vrork vdll bo complied enih wiielher sper.ified herein or noL Thn grantin�of a pemiit does not preswno to givr;au�horily to viola�o ar eancel <br /> Ihe provision of any olher s�a�e or local law regulatin�construction or Ihe perfor^�anw of consWclion.That I am aulhodzed by Ihe ov.ner of Ihis propeAy <br /> t�pr i Ihe work for vAiich applicnlion is mado and I con�ply vmh the S�ate Conlractors Law 18.27 RGN and 29u200 WAC <br /> .Oio�lAulQlio d Aycnt Si�nalum � Z Da1e (Revised 2/2011J <br /> 1/� <br />