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O0/09/2011 L19:07 2066332202 PAGE 01/02 <br />l��l I �i � 11 1 /l fDr ena�i-i del <br />r<c«en surr,� aob �13c -oa �8 <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING!SIGN/SPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Ceder St- Everett, INA 98201 - 425-267-8810 - FAX 425-257-8657 - vrrrw.everetbva.org <br />APPLICATIONS ARE ACCEPTED rROM 0 AM TO 4 PM 'Pt \og-CU�_ <br />SI <br />EADDRESS• tJ 1�5 - t to <br />PROPERTY TAX <br />PfiRMITa <br />I <br />LEGAL for new ConslNCtion Shcn oI846pb1vision Lot NC _ (ona C!r COPY Or I01g 1001 CesCnpkCn) <br />OWNER <br />Phone/Er n id <br />Address <br />C'1''State2lo <br />CONTRACTItOR i- <br />L 8 I Lic. r <br />ACGress tL, 5 ^honefEmai ��—(O 'J%) O <br />TENANT BUBINESS NAME <br />CONTACT FOR PERMIT OCQ,rv)2. IC +eVf'F7 <br />445 WC •!a5'by <br />Phonelcall m( eG ' <br />BUILDING PERMIT APPLICATION <br />ICONTRACT PRICE OF WORK Z54y1OOiO <br />Existing Use of Building HEAT SOURCE! <br />Proposed Use of Building y Gas Electric 0!her <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi•Famry -J�. Commercia' <br />Type of pro)acL _ New _ Addition _ Remodel _ Repair k T.I. _ Sign _Sprinkler _Demolldon_Change Of Use <br />Dearnpgon of Work (additional cot,ce rfr, !dad on the baeq t <br />G'irp Kd tapfL') roll,-!"', t-H".x rc,- � we <br />Have you started working without a parmit7 _— YrS NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project Now—Addn _Alteration �Repeir <br />Show Number (a) of ftrturt•s <br />Type of Prolcel _Now _Addn _Alteration _Repair <br />She. Number (a) of fixtures <br />AIC -ar hanahng units <br />I Toilet <br />Forced airs stems <br />Bathtub <br />I Gas piping <br />Levato (wash basin <br />Water heater <br />Shower <br />I Gas fireplace <br />I Kitc,en sink d disposal <br />as range <br />Dishwasher <br />101res dryer <br />C!Olh.e9 washer <br />Range hood <br />VJate• heave <br />Exhaust fan <br />_ <br />I Sink (SeNicerbar1rf ;etc.) <br />Heal PUMQ <br />I BaCkRpw preventer <br />Unit negler <br />Li Urinal <br />Boller <br />Drinking Fountain <br />Refrigeration <br />'L Floor dra'n <br />WOodslove <br />areas@ trap <br />I Ducan <br />I col drams <br />Other <br />J Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM � <br />Other: <br />Number of Heads <br />- Other <br />I I <br />I hnraby con fy that t have road and asamined this applldauon and knee the Same to Do We and Corral. All PWASOVIa of tows and otoinanns 9"fa'ing <br />this ly" of - w•il be Ce"O'a wnnlnnr tried hefeln or not. Tie greeting of a permit does not prestmta to Rive pvthatliy Io violate er WnCCI <br />C DrVvision of anV other stall' or I I taw npulaling ConsINCIibR Ot lha padormanca Or COnetnRibfl. That lam aamoriCed by the owner or Ma proSarry <br />to Odonn the work ror which pill lion Is made end? comply w11h the Stain Contractor Ln.10.27 RCW and 206 200 WAC <br />s AT Y <br />7 <br />OlAuthorited Agent Sighbluir f 0418 (Revised 24011) <br />