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. � (. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���E7 "/'2. <br /> SITEADDRESS: PROPERTYTAXM ERMIT• _` <br /> i � �� <br /> LEGAL for new conslruclion: Short PlaUsubdivision Lol No._ (a1Wch copy o(lorg legal description) <br /> OWNER � � J PhanelE-mail � ' 6 � � ! � <br /> /11.! I� , ' n <br /> Addmss i Tn ' Jv�y� � CitylSlate/LP • <br /> coNTwe,croR UY CD�t7 i 1� �a i uc.a L G'r <br /> Address (� �� /I�(% I L� " !i� ,��J 7�" �ane/Email �{Z',j- �7 ' L[ S� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �Q� �hgpRpW`a <br /> �� 5'r0 � PhonelE-mail u� o v"' ��I. <br /> Bi7i�DING PERMIT APPLICATION CONTRACT PRICE OF WORK I,fbU <br /> Exisling Use of Bullding R�'�i�L HEAT SOURCE: <br /> Proposed Use of Bui�ding R i�� Gas Electric Other <br /> Buiidfngtype: _SingleFamily _Duptex_Tawnhouse _Multi•Family Commercial <br /> Type of proJect: _New _Addition _Remodel _Repair 1[T.I._Sign_Sprinkler�Demolition_Change of Use <br /> Description of Work�additional space vided on fhe backJ: L V n� �,,!v L�,uo� R��,�� ,P,tC� <br /> �oNvgQTs�� �x�tt� uP5 REf� r �v� <br /> Have you started working wlthout a permlt9 _YES �NO <br /> MECHANICAL PERMIT APPLICATION pLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New_Addn _Altaratlon_Rapair Type of ProJaN: _Naw_Addn _Altarotlon_Rapalr <br /> SMw Num6er N)of flxtures Show Number�M)o/Rxfuroa <br /> A/C—airhandlin units Toilet <br /> Forced air s stems Bathlub <br /> Gas i ir Lavato wash basin <br /> Water healer �� Shower <br /> Gas'fire tace Kitchen sink&dis sal <br /> Gas�an e Dishwasher <br /> Clothes d er Cbthes washer <br /> Ran e fwod Water heater <br /> Exhaostfan Sink servicelbar/mo elc.) <br /> Heat um 6ackAow eventer <br /> Unit heater � Udnal <br /> Boiler Drinki Fountain <br /> Refri eratlon - Floor draln <br /> Woodslove Grease tra <br /> Ductin Roaf drains <br /> Olher Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM ��+�� <br /> Number of Heads Other: <br /> I hefreby certi(y lhat I have read and examined lhis application nnd know lhe same�o be Uue and cortect.All piovisians of laws arW ordinances govemirg <br /> ihis type o(v.ark will be complied wilh whether specified herein or not.The granting of a pertnil does not presume lo give aulMrity to violale or wncel <br /> iha provision of any other state or lowl Iaw regulating consiruclion or lhe peAortnance of consVuctior.That I am aulhorizad by Ue oHner of this pioperty <br /> tu peAortn Uie�+or1c(or wfiich applic ' n is made and I comply wilh lhe Slate Contractors Law 1827 RCW and 2362C0 WAC <br /> ��'j� ��'�6�!��� � ' l6' I'a. <br /> QwnadAutborl AgentSl�nature Date (Favisad?/2011) <br /> %a <br />