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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRIN KLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St, Everett, WA 911201 - 425-257-8810 - FAX 425-257-8857 - v vow everettwa.org <br />Ann! WATIONS ARE ACCFPTFn FROM R AM TO 4 PM <br />SITE ADs� SS: c <br />PROPERTY TAX R <br />RMIT ^ J(J ^ ^ <br />-r <br />LEGAL for new construct' ionn Shan PlaUsubdlvlston Lot No _ (attach COPY of lorq legal descnpban) <br />OWNER „5 -/r'ree7 Cam," 44C <br />PlwncIE-mad <br />Address / j O / N <br />City/State/Zip HOAt Z vNE <br />CONTRACTOR 0 , 2 4Je <br />L S I Lit A A00044 NL O Al i/ D b <br />PhondEmail./.2j-j//Q <br />Address �O / ci OStvrn' d M/t rFO .713 <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />CCi / /t AV'S pAGt <br />Phone/E-mad %4TPOLOL pate 0. O/0 d <br />BUILDING PERMIT APPLICATION <br />1CONTRACT PRICE OF WORK -$ // d00- 'A <br />Existing Use of Budding HEAT SOURCE. <br />Proposed Use of Building Gas Elednc Olt*( --- <br />Building type. _ Single Family _ Duplex _Townhouse _ Mufti -Family -ZCommercial <br />Type of project. _ New _ Addition _ Remodel _ Repair _ T.I. _,/Sgn _Sprinkler _Demolition_Change of Use <br />Description of Work (addenm aspace provided on the beck) . <br />J <br />/Y)S fa/I .51,o //ltl ,;,a/[G! W0.�� [A,6/HG♦ .1�1J7Ai. <br />Have you started working without a permit? _YES _A/NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn —Alteration _Repair <br />Type of Project: _New Adds __Alterabmi_ Repair <br />Show Number a of fixtures <br />Show Number (a) of futures <br />A/C -air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas i m <br />Lavatorywash basin <br />Water heater <br />Shower <br />Gas firelace <br />Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (servrcelbarlmo etc ) <br />Heat pump <br />Badcgow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease era <br />Ducting <br />Roof drams <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />Other <br />I hereby certify that I have read and examined this application and know the same to be true and coned All prowsrons of laws and ordinances goveming <br />this type of work will be complied with whether specified harem m not The granting of 8 permit aces not presume to give authority to violate or cancel <br />the provision of any other state m local law regulating construction or the performance Of COrlstnKtlal That I am authorized by the owner of this property <br />to perform the work to. wh h ahphcation is made and I COrrply with the State Contractors Law 18 27 RCW and 296 200 WAC <br />9 -11 <br />eHAulho lzad Agant Slgnetule Date (Revised 212011) <br />