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PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/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 r <br /># <br />SITE ADDRESS: P R IT a <br />ROPERTY 7A"ALL <br />Cyr C �I�1'I , �� � - P2r�� c �, ;i,� �Gl GG' L `''W <br />LEGAL for ner rconsWction: Short Plat/subdivision Let No._1 (attach copy of long legaldescription) <br />- '� ✓� <br />OWNER ) ,nR 1� <br />� d PhonelE-mall TLVJ D•�L{�C <br />- <br />�� C� L1G t r t rC 1• CitylStalelZ�P L�!?�Cif I SUS <br />Address <br />APPLICANT: Owners Agent Contractor _Contractor's Agent _Tenant lmmtpendeakearor rowntlmm ore ownerrodo won in ne space) :•I`` <br />—Owner <br />1 . r 1�) (� L 8 I Lic. # COE Bus. Lic. # �I <br />E. <br />CONTRACTOR i I `, 7 <br />Address 6 C ) Phonelllmad f <br />CONTACT FOR PERMIT � .Lj I J7 <br />TENANT BUSINESS Nck t <br />��jICiI-d' L11t;1��1.t'1��1'1 �if70•y5 <br />�V �. r PhonelE-mail (i, <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OFWORKJIGI� SI�L1 <br />. C,i-l? h(' /I v�:�('Il��l HEAT SOURCE. <br />Existing Use of Building <br />5G� Ne.w Gas Flectnc_ Other_ <br />Proposed Use of Building <br />Building type: Y 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 pro vided on the back): <br />Wild hew < <br />hru;S" ; <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT <br />Type of Project: &New_Addn_Alteration_Repay <br />Type of Project: <br />S weN_Addnumber /At) or fixtures e <br />Show <br />Number (#)or fixtures <br />Toilet <br />3 Toilet <br />A/C - air handlingunits <br />'1- <br />Mdisp�,sal <br />Forced airs stems <br />i Lavatory(wash <br />Gas in <br />Shower <br />( <br />Water heater <br />Kitchen sink 8 <br />j <br />Gas fireplace <br />Dishwasher <br />Gasran a <br />Clothes washe <br />Clothes d er <br />-"lale�r <br />Range hood <br />Slnketmoplelc.) <br />Exhaust fan <br />Backilow ilow prevenventer <br />Heat pum <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Reration <br />Floor drain <br />Refn <br />Gease trap <br />WoodStOVe <br />Roof drains <br />Ducting — <br />Medical Gas <br />Other <br />I SUPPRESSION SYST FM <br />Other: <br />SPRINKLER <br />I Number of Heads <br />Other. <br />I hereby car* that I have reed and examined in* application and know tie same to be true and covecl m previsions of laws and omnances governing Ines type of work Ml be remphed <br />with whether specified heren or not. The granting of a permit does not presume to dive authority to violate or cancel the prevision of any olhef state or local law regulating construction <br />That 1 am authorized by the owner of this property to Perform the work for whim application ks made and I comply with the Stale Contractors Law 18 27 RCW and 296200A WAC_ <br />Moe 01tt a)�Uw L'LeL <br />OwnorlAuthorized Agent Signature Date <br />(Revised 62012) \ I <br />