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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.everetiwa.org <br /> APPLICATIOH�ARL^�CEPTED FROM B AM TO 4 PM —1 <br /> SITEADDRESS: � PROPERTYTN(p PERMIT/ <br /> 03 � I« ,�}-L S�� D ' d I DOI G3 20S -(U� <br /> LEGAL lor new consiruclion: Short PlaVsubdivision_____ _______—__—_______ Lot No._____ (attach copy of long legal description) <br /> OWNER J � l.�j.,Q.- Phone/E-mail <br /> Address � , � [t,�. (�� , uC(� ���U CirylStatelZip Ll�i�-l-W-{j.,� L1QL,�[ � � L S / <br /> CONTRACTOR �P�VL . ,CE6'1 c�� ✓1 S'- S'�-Ci1jf L&I Lic.# � � � �1 L 7 C'. <br /> Address OU `�� , 1L.�ll�� K'�' ��l'-�"��� �/ � PhonelEmail L Z��j��c� � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT—r7��G` � S L�/Ilf� <br /> IY <br /> � ��a�� ��� PhonelE-mail L�2� '7 � ���--> <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK��V — _ <br /> Exisling Use of Building____ ______— HEAT SOURCE: <br /> --------- <br /> Proposed Use of Building_________________ Gas_ __ Electric____ O�her____ <br /> ---------- <br /> Building type: __Single Family __Duplex__Townhouse _Multi-Family ___Commercial <br /> Type of prolec�: ___New __Addition _Remodel ___Repair__T.I.�Sign___Sprinkler___Demoli�ion___Change of Use <br /> DesCription of Work(additianal space provided oi the backJ: <br /> � I�l���?1.21' �� V�-�C�.C�-P ��t�-,'1 <br /> �- <br /> Have you started working without a permit? ____YES�_NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type af ProJect: __ New___Addn ___Alteration___Repair Type ot ProJect: ___New___Addn __AlteroNon__Repalr <br /> Show Number(#)a!/ixfures Show Number(N)ol flxfurer <br /> , A/C-airhandlingunits ! Tnilet <br /> � Forced air systems I Bathtub , <br /> �; Gas piping Lavato (wash basin) ' <br /> Water heater I Shower <br /> I Gas fireplace Kitchen sink&disposal <br /> I Gasrange � Dishwasher <br /> Clolhes dryer I Clothes washer <br /> � Range hood I Waterheater <br /> I Exhaust tan I Sink(serv'�-e/baqmop/etc.) <br /> Heat pump I BackFlow prevenler <br /> Unit heater I Urinal <br /> ! Boiler I Drinkin Foun�ain <br /> � Refri eration � Floordrain <br /> \ Woodsiove � Grease trap <br /> ! Ducling I Poof dreins <br /> j Other___________ __ � � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM li Other: <br /> ' Number of Heads Other: <br /> I hereby cerlily that I have read and eaamined this applicalion and know the same to be true and correr.L All provisions o(laws and ordinances goveming <br /> Ihis type ot arork will be complied�+nth whelher specified herein or noL The 3raming of a pertnit does not presume to give authorily to violale or cancel <br /> the provisicn ol any other state or local law regulating mns�mction or ihe peAormance ol construction.That I am authorized by Ihe ovmer of this property/ <br /> to perform 1 e vrork for which aF:plication is made and I comply with the Slate CoNractors Law 1827 RCW ard 296200 WAC 1 <br /> t - 1 Z <br /> / / _ � S <br /> OwneK uthod� � g ntSignature ��ate�- (Revised21201f) <br />