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PERMIT APPLICATION <br />BUILDINGiMECHANICAL/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.Drg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />DRESS: <br />SITE ADrl <br />D DN <br />PROPERTY TAX N <br />DO 1 00 001 01—� <br />P RA11T p <br />LEGAL 1tt rxw mnsinztion shah FlaVwbdivision_ Lot No._ !a;'adh copy d bry Iytpal desruiption) <br />OWNER ei 6v <br />PhonmlE-rrail 2r (2-V j J nee 0 rl <br />Address 3 ci 0 1 flmO-. <br />atwstale P Zo I <br />CONTRACTOR T�Ae �4i' iit t��(��� <br />L8I Uc.# 11J it Y -t <br />1,1DEll n1L1,Arlri <br />L <br />roes 0 I D I e. /Y t/71 <br />^ I <br />0 PnonrJE'ra.+ �Y�.1" ;7 Lam!' 4 1 yf <br />TENANT BUSINESS NAM -T-Ne �• 1 Y1I (/ <br />CONTACTFOR PERMIT fN 0Y1 CA, <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK ' 00 t7. no <br />�' <br />Existing Use of Building ,1 ) 1t� �. HEAT SOURCE: <br />Proposod Use of Building 'IV' 4 e A / Gas Electric Other <br />Building type:_ Single Family ,_ Duplex _Townhouse _ Multi -Family `Y Commercial <br />Typeofproject: _New _Addition _Remodel Y Repair _T.I. _Sign _Sprinkler_Demolition_Change of Use <br />Description of Wolk (edditweg space pmvxyed W tho back) : <br />RG�I0.L°LV1i?Yl} OP Il�+ 5r 4- ! <br />106W A'OOV O-4K i r7(�} }1'i t C 1� r <br />Have you started working without a permit? ,_YES X NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Proloct: _Now_Addn _Altemffon _Ropair <br />Show Number Jiof fixtures <br />Typo of Project: _Now_Addn ^Ahuretlon _Repair <br />Show Number of fixtures <br />Toilet <br />A1C - air handling units <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin <br />Water healer <br />Shower <br />Gas fire lace <br />Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heate• <br />Exhaust tan <br />Sink servicelbartmo etc. <br />+ Heat pump <br />BadcBow pmvenler <br />—i'— <br />Unil heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Retrigeration <br />Floor drain <br />Woodsinve <br />I Grease trap <br />DLkcbrrq <br />I Roof drains <br />Other_ _ <br />f— <br />Medical Gas - <br />SPRINKLER / SUPPRES'.SIO_N SYSTEM <br />Other. <br />Number of Heads <br />Other <br />I hereby certify, that I have mad and examined this app4rati0n and knew the same to be true a.M cooed Ail pmvisions of taws and ordinaries gcvrsming <br />this type of work wdl he ,,,plied with whether specified herein or nor The granting of a permit does rrot wesume to give authority to violate or cancel <br />the pmwision of any other state or local law regulabrg construawh or the Performance d,nsbucbcn. That I am autnorizee by the owner of this property <br />to pedontvdhe.s(ork for Mich apOication is made and I comply with the Stale Contractors Law 18.27 RCW and 2% 200 WAC <br />Owner/Authorized Agent Slgnaluro Date (Revised 212017) <br />l (� <br />FN'1� <br />I <br />LOL <br />M <br />