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f'ERIVIIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGiSIGN/SPRINKLER/DEMOLITIUhI <br /> CITY OF EVERETT PERMIT SERVICES �—I� —�3 <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 �j - <br /> SITEAD�RESS: V PROPERNTA%N PERMITN <br /> Th <br /> LEGAL for new constructicn: S�otl Pia�subtlivision Loi No._ (attach mpy of long legal description) <br /> OWNER / � i v�n -�n� Phone/E�mail <br /> Atldre55 Cdy/Slafe/Zip L�•[/C <br /> APPLICANT: Owner Owner'sAgent Coniractor Conlraclor'sAgent Tenantlm�str�o.-aaaknerarcc�semo-omu,ew.�ernaa.ma��n:nu:a�oe� <br /> CONTRACTOR D�` �/� N� L&I Lic.# COE Bus.Lic. # <br /> Adtlress C�22 s� - .� .S��ch In ' L✓ PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE�mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exis�ing Use of Builaing HEAT SOURCE: <br /> Proposed Use of Building Gas_ Eiectric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of projecY. New �Addition _Remodel _Repair__T.I.__Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(atltlitional space provided on!he 6�;k): <br /> il� ch 5 A G•.`�>.;�•��� S /.�u7 �••�'Cv:, } <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypeofProject: _New_Addn _ .Altoration_Repalr TypeofProJal: _New_Addn _AlteraUon_Repair <br /> Shaw Num6er(H)ol/ra�ures Show Number(#)o!Iixtares <br /> A/C-av handling units I Toilel <br /> Forced air systems Bathtub <br /> Gas piping Lavalo (wash basin) <br /> Water healer � Shower <br /> Gas freplace Z Kitchen sink 8 disposal <br />\ Gas range Dishwasher _ <br /> Cblhes dryer � Clothes washer <br /> Range hood Water heater <br /> Exhaus�fan Sinl:(service/badmoplelc.) <br /> Heat pump � Backftow preventer <br /> Unit heater Urinal <br /> 6oiler Drinking Founlain <br /> Refrigerelion Floor drein <br /> � Woodstove Grease trap <br /> Ducling Roof drains i <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Other: <br /> Number of Heads Other: _ <br /> I hemby cenM«���I hme read and examined Ihls apPlicalbn una know t�o samo to Go tmo nntl cortect.Ail provisions af 1a�.5 ond orainaneef geveming ihis�a of work vnA[e compli^d <br /> with�MClner specifetl herein or nol.Tna BraNing of a pertnit tloes nol presume lu B�o authonry to vicblo orcancel�ho F�ahsion ol any other slale or loca�bw reBUWtinB�ons�vction <br /> Tnai I nm aulhorizeC by Iho a•merol t�is propeM�o pedortn Iho woA/o�w�ich aDP�ko�ion h matle antl I compy w�h the Slale ConVncton Lew 7827 RCW enE 296200A WAC. <br /> .,i9 � _'_' _ <br /> � __ I <br /> ��---- ._..__� /- //- % 3 <br /> O nerlAuthodzed Agent Slgnature �ate (Revised 6/20:2) <br /> -- �� <br />