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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 /> STTE-ADDREPROPERTY TAXA PEIIIA7T 0 103 W/ <br /> 3 '76 sr 5 W (5t 9--rT do 00 00 <br /> LEGAL foi new conshuclion Shod Plat/subdivision---Lot No._ (attach copy of long legal description) <br /> OWNER,StM A Che0.l KUR5cktocR Phone/E-mail q2-b --138c (v9 I <br /> Address 103, 7to Ir _ ; V1 eP-e7T Gly/Slale/2.ip vCR,--TT WA <br /> CONTRACTOR Sig III C L& I Lic. M <br /> lddress Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phoneir mail CkeR% SIm y25 932909 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK C 0,Je <br /> Existing Use of Building HEAT SOURCE. <br /> Proposed Use of Building (�:7) Gas Electric other_ <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family _Commercial u <br /> Type of project: L New _Addition _Remodel _Repair _T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additional space provided on the back): {� <br /> �YKJ 10 qe t I <br /> Have you started working without a permit? _YES WNO 1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: __Now_Addn _Alteration__Repair Typo of Project: _Naw_Addn _Alteration_Repair <br /> Show Number(0)of fixtures Show Number(M)of fixtures <br /> A/C—air hindling units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory(wash basin) _ <br /> Water heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas range _ Dishwasher <br /> Clothes dryer _ Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink service/bar/mop/etc I <br /> _ Heat pump Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refn eration Floor drain <br /> _ Woodstoee Grease tra <br /> _ Duchn Roof drains <br /> Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM _ Other <br /> Number of Heads <br /> I hereby certify 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 complied with whether specified herein rr not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of any other slate or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to perform Ih ork r which application Is made and I comply with the State Conbaclors Lew 18 27 RCvV and 290.200 WAC <br /> Al <br /> Owned ort goof gn tura Dale (Revised 1212010) <br />