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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 ,,v, rW.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: j PROPERTY TAX# RP 1—' �y <br /> ),Vg 7 ez:i<e t�/fr.-- Ave rect3elic eri9/C 7t O <br /> LEGAL for new construction: Short Plat/subdivision_ _____Lot No.___ (attach copy of long legal description; <br /> OWNER peey`/Qf—C /Le-- Dein,+t'//5 Phone/E-mail 1,/,-��so 'rs�/ / y�yCL��j1 Fad/ /�✓i' <br /> Address 73c 2 33.-1 4i�e A.'J !' CitylState/Zip c!_'tai AN? 10 J9//.5-- <br /> APPLICANT: Or:-er Owner's Agent '..o frac:or --Contractore Agent Tenant,mustprovidea!euerOfconse_ntfromtn_o,werroaowori<nthewace' <br /> CONTRACTOR OM/V /> IL&I Lic.# COE Bus. Lic. <br /> Phone Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATIONCONTRACT PRICE OF WORK IU�VOr <br /> Existing Use of Building_ 5 _ <br /> /�,!\ HEAT SOURCE: <br /> Proposed Use ofBuilding 6.f / _ Gas_ Electric.JC Other_ <br /> / <br /> Building type: )i Single Family Duplex__Townhouse Multi-Family Commercial <br /> Type of project: New Addition )Remodel Repair_T.L Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK'additional spacepp�rovided on the back): / i �r .L <br /> /�rft-'/�7Ei6 l /r" 1�1Jr/ i / •4,0• 7, /► f€L4' 42b'„S I y /11' /4) ,11 a'r.� tit Y AM) <br /> Lie /,4?,:�, s ��Y� r , e art I < L /1, <br /> iby, 4 <br /> At /! /p 47/14 !'/lis /'l"ft'l'C 4/!"ee'l's /'i' o' D*--i• 2,•,.2 fn <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of arojecr New_Addy _Alteration_Repair Type of Project: New_Addn _Alteration _Repair <br /> Show Number(#)of fixtures Show Plumber( i of fixtures <br /> NC—air handling units oilet <br /> Forced air systems E5-atht:,b <br /> Gas piping -avaory(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 /> 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 Other. <br /> Number of Heads Other. <br /> I hereby certify that shave read and examined this application and know lie same to be true and correct All provisions of laws and ordinances governing this type of work wit be complied <br /> wdh whether specked herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That lam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC <br /> '46. �, a ( /7-13 <br /> Owner.Authorized Agent Sigrature ete (Revised 6/2012) <br />