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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPR.INKLERIDEMOLITION <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 /> SITE ADDRESS: i C�C7 tI g_i �V�zYL -� t PROP 41!Q c I OClC TOO CVV RMI N- 1 —Q <br /> LEGAL for new construction: Short Plat/subdivision --Lot No. (attach copy of long legal description) V <br /> OWNERTT�-- 7'Fe-(C k .LiZ.� 1nL Phone/E-mail L'�j 2 �-3iT 1 61 <br /> Address G 9 F1 I-6 1,JC-11 Rd City/State/Zip L,�`'e c+f L) 9 ZC S <br /> CONTRACTOR H 0 m L&I Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME NTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building G A ft.n-t e I HEAT SOURCE: <br /> Proposed Use of Building W Y r A`1 Gas Electric_ other_ <br /> Building type: Asingle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition .X Remodel _Repair_T.I._Sign_Sprinkler_Demo]ition_Change of Use <br /> Description of Work(additional space provided on the back): I&-,I-�t r 11J <br /> _C Z J)r-'o r j I S 1 0 is i g t t et. L', Iest (�c� , 1>�S <br /> LOA 0-S; I w A.-r(? 'Z 12)tom►k' A�Dv 1ecz M,�i�q � <br /> Have you started working without a permit? _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: X_New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> i Water heater Shower <br /> ! Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan X Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: i O—C CY)A<t--\ <br /> Number of Heads I Other: <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 wits complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of any o er state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to perform the wor cr�//' <br /> h licati is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> �� <br /> Owner Authorized Agent Signature Date (Revised 2/201/`%) <br /> L <br />