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PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St, Everett. WA 98201 - 425-257-8810 — FAX 425.257-8857 — www.everettwa.org <br />•PE ACCEPTED FROM a AM TO 4 PM <br />SITE ADDRESS: <br />PROPERTY TA%% <br />PPR 1TS <br />2O ll�J <br />TA <br />LEGAL for new constucton Short Plat1su1hd1vi5iori_ Lot No _ (altach copy of long legal description) <br />OWNER T <br />PhoneE-mad .3S _JFbEn <br />Address t i TN Ave ,,,r c, <br />CdyiStaenp _Cvrel A <br />CONTRACTOR o I L 8 I Lic. ff G N t <br />Address 17A a WA did021Phone Emad y$D <br />TENANT BUSINESS NAME <br />CONTACT FOR <br />,tPERMIT <br />LACCr/ /v•M°trE <br />T C <br />PhonEma l I- Act, 1 <br />e <br />BUILDING PERMIT APPLICATION ICONTRACT <br />PRICE OFWORK•A(,z, 4C, <br />HEAT SOURCE. <br />Existing Use of Building <br />Gas Electric Omer <br />Proposed Use of Building <br />Building type: Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />_ <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) <br />Have you started working without a permit? _YES _NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project: _Nev, ✓Addn _Alteration _Repair <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number 01 of fixtures <br />Show Number (0) of fixtures <br />A1C — air handling units <br />Toilet <br />t <br />Forced air systems <br />Bathtub <br />Gas <br />Lavalo (wash basin <br />Water heater <br />Shower <br />Kilmer, sink 8 disposal <br />Gas fireplace <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Raiiiiiiii le hood <br />Water heater <br />Exhaust fin <br />Sink servicelbadmo letc. <br />BackRow preventer <br />Heat if D <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Refrigeration <br />Floor drain <br />Woodslove <br />Grease tra <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER SUPPRESSION SYSTEM <br />I <br />Other <br />Number of Heads <br />I Other. <br />1 hereby cendy that I have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing <br />this type of work will be compiled Nth whether specified herein of not. The granting of a permit does not presume to give authority t0 violate or cancel <br />the provision of any other state of local law regulating construction or the performance of construction That I am authorized by the owner of this property <br />to perform the work for which application is made and I comply with the State Contractors Law 18 27 RCW and 29e 200 WAC <br />Ce/r/r i_ <br />gwmerlAuthorized Agent Signature 11 Dale (Revised 7/201 f) <br />��L <br />