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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 CAN 11.O 2-- 00 .- <br /> SITE ADDRESS: PROPERTY TAX# PSR ii A MLS <br /> '9Q moi' t ,erre , ie O-V65.tter r <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> OWNER"i2f,O I. t- p,/t,PtAte:C 5 Phone/E-mail ,----.. <br /> Address 5---1A , 02xi-e2 City/State/Zip / (..r c___ 461/4 �y <br /> / 9 SO 6,3 <br /> CONTRACTOR j ^e,. QW �iL L&I Lic.# <br /> Address 5729 Delr'eye_.ve i 1'e/er+; 5e..,20.? Phone/Email &p S 7 Cal 2_.."? <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 3-0 Cl2 5-5-1 oil(.- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK TOCn.0 0 <br /> Existing Use of Building -' — HEAT SOURCE: <br /> i <br /> Proposed Use of Building,i t.37 C� �.4.1 Ik e Gas_ Electric r/ Other <br /> Building type: _Single Family ( Duplex_Townhouse _Multi- amity _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 /> X49 Vj LW c) le .t Q g.c.1 65 c.3A c tS LcW ke. ei t-z23 e7 Cjg2.tb 2e- <br /> t c 1L-46 S c--'v— <br /> Have you started working without a permit? V YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addnterationepair Type of Project: _New_Addn ./Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> 1 NC—air handling units A �1 Toilet <br /> Forced air systems [ Bathtub <br /> f Gas piping _ Lavatory(wash basin) <br /> I Water heater le, I Shower <br /> ` ► 1 Gas fireplace Kitchen sink&disposal <br /> I Gas range Dishwasher <br /> Clothes dryer 1 ( Clothes washer. <br /> Range hood Water heater <br /> ai Exhaust fan f Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> of Boiler Drinking Fountain <br /> Refrigeration f Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other 4 AS 14-/ <le/VD., 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 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 f9 ich application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> ' ,�`' /-1.3--.2°/ Z <br /> Own /Aut fie Agent Signature Date (Revised 2/2011) <br /> g g C�Z <br />