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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLER/DEM^'LITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM /Q—IN�� <br /> SITE ADDRESS: � pROVERTY 7A7f q PERMIT# <br /> ��Z_ S 3/0- D I <br /> LEGAL Inr new conslruqio¢ Short Plal/subJivision_� Lo�No._ (a�tach copy oi long legal descnption) <br /> OWNER `QL� PhoneiE�mail <br /> ACtlress l l � � �� CilylSlate/Zip � g�� <br /> CONTRACTOR �1 ��1 L 8 I Lic.fl '� � <br /> Address �� ,�1 L` Phone/Email y�7 7��3 <br /> TENANT SINESS NAME CONTACT FOR PERMIT•-fyy , , a, �` <br /> /�'7 / i/�.Ci(J� <br /> � PhonelE�mail —l/�� [,p� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_���-J�'�_____ _ _ _ <br /> Exisling Use of Building_ ____________._____________ _ HEAT SOURC[: <br /> Proposed Use of Building___ _______ _______,_ ______ Gas__. Electric____ Omer___ <br /> Building type: _Single Family __ Duplez_Townhouse ___ Multi�Family Commercial <br /> Type of projecC ___ New __Addition ___ Remodel ___ Repair__ T.I. _�__Sprinkler__Demolition._Change of Use <br /> DesGription of Wark(additioual space provided on Ibe backJ: �� �/` !'�f.(� <br /> �n�- ' l/��n G�- <br /> Have you staRed working wi�hout a permit7 ___YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMI7 APPLICATION <br /> Type o}Projoct: __New_Addn ___AlMration__ Repiir 7ype ol Projoct: _Now__ AEdn __Alteration __Repair <br /> Show Num6er(NJ ol�xfures Show Number(pJ o/�xfures <br /> A/C—air handlin units Toilet <br /> Forced air s slems Bathtub <br /> Gas i in Lavato wash basin <br /> Water healer Showcr <br /> Gas fire lace Kilr.hen sink 8 di; osal <br /> Gas ran e Dish�+vasher <br /> Clothes d er Clolhes washcr <br /> Ran e hood Waler heater <br /> Ezhausl lan Sink(servlcr,/baqrno iletc. <br /> Heal um B�ckllow revenler <br /> Unit heater Urinal <br /> Boiler Drinkm Fnwtlam <br /> Relri<eration Flooi drain <br /> Woodstave Grr.ase tr:.p <br /> Ductin � Rool d��ins <br /> Other_ Medical Gas � <br /> SPRINKLER I SUPPRESSION SYSTEM O�her: <br /> Number ol Heads I Othcr: <br /> I hereby tetlily t�al I have iead and examinea Ihis apphc:tlmn antl knnw Ihe 5amc lo be�me and mrter.l.�II pmvisions of lavr.ancf nrrlmances c�overning <br /> Ihis type ol work vnll he eomplied wiV�wlrether spedficd he�cin nr nol.Thr.granlinp of a permit Unes nol p�esume l0 9rve aulhonty lo violaie nr eancel <br /> 'ir,pi �ision o�any othei slate or lo�il law rr.gulnling consimcuon or Ihe peAmrtiance ol wnsinichon.Thal I,m aullronzed Uy Ihe owner ol�his propetly <br /> o pe n he v.nrk lor wluch ap pcallnn is made and I comply with Ihe Slale Convaclors Law 1927 RCW anJ 29fi100 WAC <br /> lv <br /> 0 nar riz AgenlSignaturc Date (Rev�snd7/JOII) <br /> \I U <br />