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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />9 � zz- (/ <br />SITE ADDRESS: ^ ^ / / f-lt <br />/Short <br />PROPERTYTAXIf2—O (0O/ Ol <br />IT' _002 <br />LEGAL for new construction. PlaaUsubdivision lot No._ (attach copy of long legal description) <br />OWNER f,, ✓1 Sri Vvoz <br />Phone/E-mail <br />Address ;" S / <br />/' <br />CitylSlaletzip 11 kle—r <br />APPLICANT: —Owner _Owner's Agent _Contractor _Contractor's Agent _Tena�ntt(musipraMae meter of wnsenPmmthoev:ner to do workm"space) <br />CONTRACTOR / <br />State Lic. # 2 2kNl City Bus. Lic. # i1 Iled <br />yzs3�7�ss�ra @A�2sa✓-✓c <br />Address Phone/Email <br />TENANT BUSINESS NAME <br />CON B,CT FOR PERMIT <br />2«a,,,4c <br />jewy <br />PhaneyE-mail Y75367,155/ 2SrJVlCe <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Buildings __ _ HEAT SOURCE <br />Proposed Use of Building San G Gas_ Electric X Other__ <br />Building type: Single Family _ Duplex _Townhouse _ Multi -Family _Commercial <br />Type of project: New yRemodei _ Repair _ T.I. _Sign _Sprinkler _Demolition_Change of Use <br />_ —Addition <br />DESCRIPTION OFWORK (additional space provided onthe back) :rc.iui re, /�cc T�1GTuNi NS'/ri%/ rPCJ /UM/11 <br />M <br />idHe <br />pep , P,p, gGfdal <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERIv11T APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Type o1 Project: _Now _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Show Number (H) or fixtures <br />AIC —air handling units <br />Toilet <br />Forced air systems <br />I Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />I Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />j Clothes washer <br />Range hood <br />Water hea!er <br />Exhaust fan <br />Sink (servicelbar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boller <br />I Drinking Fountain <br />I Refrigeration <br />I Floordrain <br />Woodslove <br />I Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number o1 Heads <br />Other: <br />sr. Co,,, <br />I nereby ceday that I have road and examined this application and know the same to be two and mnect. All provisions of taws and mdmances govem:ng this type of work wi.1 be complied <br />With whether speared heroin or not The granting of a perms tl 1 presume to give authonly to violate or cancel the provision of any other state or local law regulating consaudiun <br />That 1 am authorized by he er of this property to pertorm 1 sw for which application is made and I comply with the Slate Contractors Law 16.27 RCW and 296.200A WAC. I <br />1� <br />— zz z <br />Owncr/Aut iz Agent Signature Dale (Revised 3R017) <br />