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i <br /> ERMIT 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: 4��5 �'r,N ��� �,� ��? �t-fiC'��C PR�iPERTY TAX# PE IT# <br /> l U -�C.C�S►��° I G.Z(-�L�` % / � <br /> LEGAL for new construction: Short Plat/subdivision��/li ti�L� �2k� Lot No. �� (attach copy of long legal description) <br /> OWNER ���I�'1 i�i� ��r-, � rr��cu,s�; �� � pu.m�etcana�����e�. ccrn <br /> �li�/7�(„1�I 1 �� Phone/E-mail ��i ' � � c-/ <br /> Address tC��S C�'`��ti '� t-� 5 I_ � City/State/Zip ��(,'� �L�(l.fF �1.� '� `l����� <br /> CONTRACTOR PI��(r11�/ti �Y�17�1�J1.'l I—l� L& I Lic.# ���1��1- ��QG7�� L' <br /> Address ���'�5 C`'��'�_ �,� � C��1< � ��.�,L�y��-),� `7�i_� Phone/Email �zS.3)8`1 �'l�-LC� x �c� <br /> � Z��3 rnu���n � � �� ;�� � �/��� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIj ,��m <br /> ma�.��� v��� s.���r�� (�s:3���r� ��;tio����., <br /> Phone/E-mail l�1VU/ISIlCr1.P� �� .�f/�'�,( ' � 'i ' ('�`)�) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building /�)/,iT HEAT SOURCE: <br /> Proposed Use of Building .5�/�(� f�}f`�l Ll./ 1��51��/��� Gas�( Electric Other <br /> Building type: �Single Family _Duplex_Townhouse _Muiti-Family _Commercial <br /> Type of project: �New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DesCription of Work(additional space provided on the back): �- <br /> Cc�n�s�,c.Lchon � c� �e.�; ��n�Q �c�� h��- �I� <br /> I� Zv <br /> Have you started working without a permit? YES�NO �,Z <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 fxtures <br /> A/C-air handling units � Toilet I�I e <br /> Forced air systems �, � Bathtub ! ? <br /> 3 Gas piping ; � Lavatory(wash basin) � � <br /> Water heater Shower I <br /> � Gas fireplace � Kitchen sink&disposal <br /> � Gas range ? � Dishwasher g <br /> � Clothes dryer i � Clothes washer <br /> I Range hood , j Water heater <br /> 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 /> �7J Ducting ' ' Roof drains � <br /> Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> INumber of Heads 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 p visi o y ot r state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to pe rm e wo or hich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> � �� �t�►?..0��F ���t� I 1 <br /> Owner uthorize Agent ignature Date (Revised 2/2011) <br /> '/Z <br />