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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRI(dKLEFt/DEMO�.ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettv✓avolrga <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � `� <br /> SITEADDP.ESS: � PROPERTYTA%p ER T% <br /> 555 1"1 5''� �' e �1.� I�D -c� <br /> LEGAL for new conslruCion: Short PlaVsubdivision Lot No._ (altach copy of lang leca�description) <br /> OWNER � L- � '� Q t� Phonel[-mail �� <br /> Address CitylSlatelZip <br /> APPLICANT: Owner ' Owner'sAgent Conlracror Con�ractorsAgent _Tenantlm�s�pmraeaianeroi:.ons�miwmmaowr�ermao.ort�nmasva=el <br /> CONTRACTOR �� �� S '1 S ( ' L&I Lic.# COE Bus. Lic.# <br /> -����� .- <br /> Address 3(71 l.���'.� i:�4J _S av� /�✓�� %1 IPhoralEmail �{l -�f'-Z (%'7 -� �D� <br /> TENANT BUSINESS NAME ' CONTACT FOR PERMIT <br /> Phon=_IE-mail <br /> BUILDING C�'cicMlT APPLICATION CONTRACT PRICE OF WORK�`'(�� � <br /> Existing Use of Buildiny_ _ HEAT SOURCE: <br /> Proposed Use o(Building ^ Gas_ Electric_ Other_ <br /> Building type: _Single Family ^uplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New _Addilion _Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> DESCRIPTION OF WORK(addrtional space provided uri the bock/: <br /> � ci �{_� Vc�G'vvt �� n �v�G�� l � hc'{ G�V � V'C'�� Y2�qiV' � � �� ��•1'� /"(_ 100U' I �l�'1 <br /> � , J <br /> MECHANICAL PERMIT APPLICATIQTI PLUMBING PERMIT APPLICATICN <br /> Typo of Projecl: _New_Addn _A!foration_Repalr Typo o(ProJect: _Now_Addn _A�teratlon_Ropalr <br /> Sbow Numbcr(q)ol lixfures Show Number(il)ol Iixtures <br /> � A/C—air handling units '� Toilel <br /> � Forced air sys�ems I BatMub <br /> Gas piping � Lavatory(wash basin) <br /> � Water healer 'i Shower <br /> � Gas fireplace Kitchen sink 8 disposal <br />� � � Gas renge 'i Dishwasher <br /> � Clothes dryei i Clothes washer <br /> � Ranga hood I Water heater <br /> � � Exnaust fan i Sink(service/badmop/etc.) _ <br />� � � Nzat Pump I Back9ow prevenler <br /> Unit heeler I Urinal <br /> I I Boiler I Drinkinn, Feunlain <br /> Refrigeration I Floor dram <br /> �� Woodslove I Grease trsp <br /> � Ducting I Root drains <br />� � Other � Medical Gas � <br />�, SPRINKLER 1 SUPPRESSION SYSTEM � Omec <br /> I Number of Heads i Othec <br /> I heie6y certity Ihat I have read and examinetl this apPlicatior.antl knrnv Ihe same to be irue antl cormct All pmvisions ol laws antl ortliwnces 9oveming Ihis type ol work will be complied <br /> wnh whether speu(ietl herein or not.Tho graNln�ol a perm�t Coes not presumo m giva aui�oriry to viola�e or cancel t�c a�o�:p�on p!any ot�er state or lowl la.v regula�ing wnstruction <br /> That I am author¢eJ Oy�he ouner elt�is propetly to pedorm the work lor whic0 appliwtion is matla antl I comply wvh IDs Stute CorSractors Law 1927 ftCYJanE 296 200A WAC. <br /> .��-- � f .� , <br /> �- , ��-� �_2 - r.�- <br /> OwnorlAutborizedA ent�Signaturo Dale (Revi;edG2012J <br />