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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/ AXCP q_Oo 3 3 PERMIT,)}//i0_012- <br /> 2�'!OZ LuGK�2 �lvE 4-F-1 ��Y�{v� �/�Jl <br /> LEGAL for new construction: Short Plat/subdivision EVe rZE T ('L-A V Lot No33-36(attach copy of long legal description) <br /> OWNER RC1' 1/41-C)1 XZ Phone/E-mail .� ., G I <br /> Address Cl Z,Re -2 '14'N (We_ NW ACity/State/Zip 5& : `.luE- / btAidl C U� 1 i -1 <br /> CONTRACTOR L& I Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT 1...„1,4-n' wASSE <br /> F�A� l�A 2,0(••• 40S - zi'3"1 <br /> PkA-NO F.tTN£SS Phone/E-mail Vh A-Tr-Q S4UCflL1Ci-r rEc tAILE <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK (10 '`'O '—t <br /> Existing Use of Building 611--T G.A.-LAS 1Pkvio RsOkitt HEAT SOURCE: <br /> Proposed Use of Building t P L-'V C,Lu '( / 5-rocC e Gas Electric Other <br /> Building type: Single Family Duplex Townhouse Multi-Family X Commercial <br /> Type of project: New Addition Remodel Repair <br /> 'K T.I. Sign Sprinkler Demolition Change of Use <br /> Description of Work(additional space provided on the back): I,`v YTS MAU2 Vt4A ION PAC-Al-I @ VJ S 'jam .,N 93111J-lo <br /> &-1 WI A' A cA4Pet.N€ of uSof APPrzoY. "40 OD s F oF <br /> Avco (,Pra.F1-r.GE. -to c- ii -'5S <br /> Have you started working without a permit? X YES NO DEMO I P„) (,rA4cvC <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 /> 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 /> 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 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 /> I. <br /> 4 d ' <br /> Oer/Authorized Agent Signature Date (Revised 2/2011) <br />