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PERMIT <br />r <br />APPLICATION <br />BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />329� Cedar St., Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />".10TCn cone ■ AY Tn A PM (J—/ 3 <br />IV APPLIOAI IUMO Anc nwc� <br />PROPERTY <br />. �.......... ...�.. - - <br />TAX N <br />PERMIT <br />SITE ADDR SS: , <br />L <br />LEGAL for new construction ShortPlaVsubdrvision Lot No (atlach copy of long legal description) <br />C/ <br />r" Phone/E-mail <br />�.f `� Cdy/Stale/Lp <br />hddress l <br />CONTRACTOR - CPU �l 1) it I L)ic. N A <br />(L/8 <br />Address f l �` -1. Phane'Emall <br />/ � <br />T,EI�NNANT BUSINESS <br />CON'T'(A T FOR PERMIT( <br />< It / ,� <br />II ,NAME L <br />�ir" 1 1 7� 'I J <br />Phune , Ai' (' <br />-(�blS <br />CONTRACT PRICE OF WORK '1,.?"-l7--___--- <br />BUILDING PERMIT APPLICATION <br />HEAT SOURCE <br />Existing Use of Building- <br />:,� Electric ()(he, <br />Proposed Use of Building__ <br />Building typo: _ Single Family __ Duplex ___Townhouse Multi -Family mmercial <br />T.I. Sign _ Change of Use <br />ition Remodel ___Repair _Sprinkler _Demolition_ <br />Typeofproject: _New _-Add-__ -__ <br />Description of Work (additional sparo provided on the back): ^ <br />Have you started working without a permit? YES NO <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: <br />New Addn Alteration Repair <br />Type of Project. New Addn Alteration Repair <br />Show <br />Number (/) of NafuRs <br />Show Number (a) of futures <br />NC - air handling units <br />Toilet <br />Bathtub <br />Forced air systems <br />� Lavafo /wash basin) <br />Gas pipm <br />Shower <br />Water heater <br />Kitchen vnk 8 A�sposal <br />Gas fireplace <br />Dishwasher <br />Gas ran <br />washer <br />Clolhe5Clothes <br />Water heater <br />P.an c <br />Sink tserwce/barlmop/etc I <br />( <br />Exhaus <br />Backnow preventer <br />Heat pu <br />Urinal <br />Unit he <br />Drinking Fountain <br />Boiler <br />Floor dram <br />Refrigeration <br />Grease trap <br />Woodstove <br />Root drams <br />Dustin <br />Medical Gas <br />Other— <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other. <br />Number of Heads <br />Other. <br />I hereby certify that I have read and crammed this application and know the same to W true and correct NI provisions of laws and ordinances governing <br />this type of work will be comphed with whether specified herein or not The granting of a permit does not presume to give authenty to violate or cant"' <br />the.plo,sim of any other stale or local law regulating construction or the performance of construction That I am authorized by the owner of this propsny <br />171 <br />)he work fowhichapContractorslication is made snit I comply with this Slat" Cote/ra7dors Law 18 27 RC1'1 and 296 200 wAC <br />4. c..' (Revised 212011) <br />O�rner/Authorized Agent Signature D le <br />