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PERMIT APPLICATION <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 <br /> SITE ADDRESS: r PROPERTY TAX If PERMI N <br /> le 10 <br /> LEGAL for new construction Short Plat/subdivislon_ Lot No._ (allach copy of long'egal descriplton) <br /> OWNER /-e'rl J/a/)y ,,11 Ptione/Email (42J Jj.lij— l2 94 <br /> Address i/ BOJ tE (l SC 6veretl 98Z.;i 3 CnylSlalelzlp L l (rc: fir' /'/ J e t-Y,.,11 <br /> CONTRACTOR Lin da,,C ei L 8 I Lic.N <br /> Address1 ;�� .'tn _�%l U ;I P,,11 ,V Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/Email <br /> BUILDING PERMIT APPLICATION CON fRACT PRICE of WORK )f <br /> Existing Use ofBuilding hc'.+n[!rHEAT SOURCE: <br /> Proposed Use of Building qe'S 1 de.,If rt / Gas Electric Other <br /> Building type: K Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of pro)ect: _New _Addition _Remodel _Repair_TJ._Sign_Sprinkler_Demolition_Change of Use <br /> Descrlplion of ork(ad gQdlonaf spadeQrovlded on the back): <br /> lrls'Yr::�/u Oh of 9�*S �jr•?(�/�1aC'. , <br /> Have you started working without a permit? YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project 1New_Addn _Alto:atlon_Repair Typo of Project: _Now_Addn _Alteration_Repair <br /> Show Number 1N)of fixtures Show Number(N)of/IxNnes <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas p1ping Lavatory wash hasin <br /> Water heater Shower <br /> Gas fireplace _ Kitchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> _ <br /> Range hood Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit healer Urinal <br /> Boiler Dfinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease tre <br /> Duclin Roof drains <br /> Other Medical Gas <br /> SPRINKLOR I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> 1 hereby certify that I have read and examined this applica!lon and know the some to be true and correct.All provisions of lives 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 provision of any other stale or local low regulating consimctlo,r or the performance of construction.That I am authorized by the owner of this property <br /> to perform rk for which application Is made and I comply with the Slate Contractors Law 18 27 RCW and 298 200 WAC <br /> OliaefflidAuthorized Agent Signature Dale (Revised 212011) <br />