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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—ww.everettwa.org <br /> /0—iw <br /> 5 APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRE7003 C A'J n /, /J � 15 j <br /> PROPERTY TAX# PERMIT#^ - 007LEGAL for new construction: Short Plat/subdivision P Lot No. (attach copy of long legal description) <br /> OWNER Be E 1 1V & Phone/E-mail <br /> Address City/State/Zip <br /> CONTRACTOR I Fj D L t.\(A( ,t- L&I Lie.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 8 o6-) /J 6 Phone/E-mail f 6d mss ' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /PO/d 0 C) <br /> Existing Use of Building CO'r-1 Cie HEAT SOURCE: <br /> Proposed Use of Building ��F 1 C Gas Electric_ Other_ <br /> Building type: Single Family _Duplex_Townhouse Multi-Family LY Commercial <br /> Type of project: _New _Addition Remodel _Repair x T.I._Sign_Sprinkler Demolition Change of Use <br /> Description of Work(additional space provided on the back): <br /> If LE it/a i'Lk O(LP 1G L: g- <br /> Have you started working without a permit? YES x NO <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 /> top orm the work for which application. made and I coly ith the State Contractors Law 18.27 RCW and 296.200 WAC <br /> 7 <br /> wner/Authorized Agent Signature Date (Revised 2/2011) <br />