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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 /> SITE ADDRESS: PROPERTY TAX# P,FRMIT# <br /> 7-15- vJ Mvk;(+ea ��vd. -015 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Ove 5exwar5 L vP,,,—lac,04wcA— Phone/E-mail HZ�-Z'I <br /> Address 2.t5 W Mok:14c � <br /> o Av d• City/State/Zip EVG/2 tt V.✓A, QSLO'S <br /> CONTRACTOR 0% motor 4 L&I Lic.# <br /> Address '14I0 MoAA,Sw 4. t-�-Veee-k\JA g87.03 Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOP P�RMIT <br /> C;V I C' A& <br /> CNY LL4t'eCpK t­�Vr Phone/E-mail 4tZ -.-L q •os C�tr�S,Y'acFa�6►,Mcartll•cath <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKP10.10!CC) .00 <br /> Existing Use of Building CA4&C-L, n-(C'5GI1oo HEAT SOURCE: <br /> Proposed Use of Building C.!WUWa'� pre-56%oot Gas_ Electric_ Other. <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family —Commercial <br /> Type of project: _New —Addition _Remodel _Repair /T.I._Sign_Sprinkler_Demolition_Change oTILse <br /> Description of Work(additional space provided on the back): V <br /> A,a.1 0) rev`17-av, aub (Z) �� 4bex,skrt�5 pie-scl►oot b��k I�rc! . <br /> AAZ U)al t i,' +6 a K,sArn,S (""" �F1co r 1eJd. <br /> Have you started working without a permit? _YES _VNO 40 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _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 /> I Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> f Exhaust fan 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 I Other: <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 will be 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 other 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 work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> S z 5 <br /> Owner/ u orized Agent ignature i Date (Revised 2/2011) <br />