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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 1CCEPTED FROM 8 AM TO 4 PM <br />SI Ez DDRESS:T� > ^ <br />PROPIRTY TAX 07�'+yIZOO �7 <br />PERMIT <br />/ <br />�' <br />Ice w <br />� <br />LEGAL for new construction. PleVsubdivision <br />Lol No (attach copy of long legal description) <br />(nShad <br />OWNER ctr.L�JCiCl6C �t� �i <br />Ph one/E-mail <br />--µµ <br />Address -T <br />' 1 <br />CltylSlsle/Zip UJ � <br />A 5 o C <br />CONTRACTOR x!•S Lt f <br />L 8 1 Lic. N <br />Address �Il <br />ZZ// <br />rl:N�W oof!IEinail S z <br />TE<�T BUSINESS NAM <br />CONTACT FOR PERMIT <br />II •�•� e f � cA . U-,� <br />PhonciEmail .Z� C l <br />BUILDING PERMIT APPLICATION <br />coNTRADT PRICE OF WORK ��✓ <br />Existing Use of Budding <br />HEAT SOURCE <br />Proposed Use of building r—•'i4.1.1� <br />Gas Ekclrtc omcr_ _ <br />Building type: _ Single Family _Duplex _Townhouse _ <br />Mul' mily Commerdel <br />Type of project: New _ Addition _Remodel _Repair <br />_ T.I. _Sign _Sprinkler _Demolitlon__Chartge of Use <br />Description of Work (eddTional apace provided on the back): <br />O �c-'e � f�=t i •� GQ <br />� ISt r NJ <br />r Ce`�r�L1000Ge <br />/ <br />Have you started working without a permit? _YES NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING HERMIT APPLICATION <br />Typo of Project: _New _Addn —Alteration _Repair <br />Typo of Project: _Haw _Addn —_Alteration _Repair <br />Show Number(N) of fixtures <br />Shaw Number (N) o/Ilxfurea <br />A/C - airhand!In unite <br />I Toilet <br />Forced at; systems <br />Bathtub <br />Gas i in <br />Lava crywash basin) <br />Water neater <br />ShoNer <br />Kitchen sink R disposal <br />_ <br />Gas fir,+place <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust tart <br />Sink service/harlmo lets. <br />Heat um <br />BackBow preventer _ <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refri erellon <br />Floor drain. <br />Greene tra <br />Woodstove <br />Dustin <br />Roof drama <br />_ <br />Other <br />Medical Gas <br />SPRINKLER /SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />LL «tip <br />I hereby certify that I have read and examined this applicelion and know the same to to Into and correct. All provisions of laws and ordinances goveming <br />this type of work will be compiled with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the prove.ion of any other statu or local law regulaling construction or the performance of construction. That 1 am authorized by the owner of this properly <br />to pr rm the work for which applicallon Is made and I comply with the State Contractors Lew is 27 RCW and 2a8 200 WAC <br />y/;Z <br />Owner/Authcrized Agent Signature Date (Revised 2/d011) <br />2 <br />