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0 - . , i � ­ .' imm M. <br />PERMIT APPLICATION - 1. 1 - - <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �J g <br />SITE ADDRESS: # <br />I u 2Li - 2-1 5 1 _ 01 h- WeS` 0 <br />7 <br />PROPERTY TAX ItPERMIT <br /># <br />I0-1-043 <br />LEGAL for new construction: Shad Plat/subdivision Lot No._ (attach copy of long legal description) <br />I U <br />OWNER TU i t�,S b FF <br />PhonelE•mail �%' <br />1 ZJ — <br />Address 07 Z,e{ ZI $ t YI ,' 4 (3 <br />citylstatelZ iP ��j, re <br />`WC-5T <br />CONTRACTOR LU — —/ RC✓tT Ai. <br />L & I Lic. <br />Address 12(� c�Kf Phone/[mail b f ZS 2-57 — 3 // <br />TENANT BUSINESS NAME <br />CONTIA/TT FOR PERMIT / 1 <br />Phonmat" CAeJ LD (`f'zS� <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK C 1 <br />Existing Use of Building <br />HEAT SOURCE: i <br />Proposed Use of Building <br />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) : I <br />�U2fJIS�f i 1Ac� ��.GHeSS Fb4� <br />Have you started working without a permit? _YES ',4NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn -_Alteration _Repair <br />Show Number (#) of fixtures <br />Type of Project: _New_Addn _Alleratlon _Repair <br />Show Number ($$) of flxfures <br />A/C — air handling units <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water healer <br />Shower :.► <br />Gas fireplace <br />Kitchen sink & disposal I <br />Gas range <br />Dishwasher -! <br />- <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink service/bar/mo lelr,. <br />_ <br />I -feat pump <br />Oackflow, preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other_ <br />_ <br />Medical Gas V <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />r <br />I hereby certify that I have read and examined this application and know the same to be (rue 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 permit does not presume to give authority to violate or cancel <br />the provisio of any other state ca law regulating construction or the performance of construction. That I am authorized by the owner of this properly <br />to parlor he work for whit applical' n is mpdo and I comply with the Slate Contractors Law 18.27 RCW and 290.200 WAC <br />OwncklAuthorized Agent Signature Date I (Revised 212011) <br />