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PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBING/SIGN/SPRINKL.ER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St , Everett, WA 98201 -425-257-8810 - FAX 425-257-8857 -www.e��eret org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM ` O�"�Z� <br /> SITEADDRESS: e �JL�.'/ �z3 oROVERTY7A%p ��5$(�� - QER,fy11,T# <br /> C IYA. O : 0 0o C.. 1/V� Z <br /> LEGAL fa new wnstructio¢ S�oA Piatlsu6division �o�No._ (aUach Copy ol lOng Iegai tleSCnp�ion) <br /> OWNER � � �ct12 U �!A/ PnonelE�mai�4��8 �63� Oc.y�.t�lond2ahofmai�: !Yl <br /> amess132 ��N Pl•SE�fj �1-M�A-4�3�8 CiryiS�ate�ZiP EV YB�� W� qBZo$ <br /> CONTRACTOR ��D/1 � L&I Lic.# <br /> ACress PhonelEm`ai� $- 3$ 3� <br /> TENANT DUSINESS NAME CONTACT FOR PERMIT <br /> / <br /> PhonrJE�mail i <br /> BUILDING PERMIT APPLICATION CONTRACTPRICEOF WORK 'r�O��� <br /> � <br /> Existmg Use of Bui'Oing / / /�5,� HEAT SOURCE: <br /> Pmposed Use of/Building �//� � / Gas__ Ekcinc � Other_ <br /> Building type: �Single Famiry Duplex_Townhouse _Multi-Family _Commerciai <br /> Type ot project New _Addition _Remodel _Repair�T.1._Sign_Sprinkler_Demolition_Change of Use <br /> DesuiptionoFWork(addifionalspace roviCedon(heback): (J✓fSiO�L�; 5!�/di�9/ W'�d0!!/S1 6v/tCrS� DiO�i7 <br /> foi bvffr�SJ e+�el�� Ufi/.'LJ. ioorti� fCnC�'i j/O�v�, ,�w:of <br /> � <br /> � r <br /> Have you started work�ng without a permil7 ✓ YES _NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New_ACOn _Alleratlon L�cepalr Type of ProJect: _New�Addn _Alterallon�epalr <br /> Show NumEer(a)of lirlu�es Show Number(pJ of flnums <br /> AIC-air handiing umts Toilet <br /> Forced air 5 stems Bathtub <br /> Gas pi i Lavato (wash basin) <br /> Water healer Shower <br /> Gas fre lace Kitchen sink S disposal <br /> Gas ra� e Dishwasher <br /> / Clothesd er Clotheswasher . <br /> / Range hood Water heater , <br /> Exha�st fan Sink service/badmop/etc. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain , <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ductin Z Roof dwrn ✓(//f <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> NumDer of Heatls � Other . <br /> 1 here0y cenity Ihat 1 have reatl anA e.aminee Ihis application and knnw I�e same to�e Ime anA correcl.All provisions of laws and or0�nances governino � <br /> I�is tyDP of work will 6e complie0 wlh whethcr speaficU herein or not.The grontin9 ot a permit tloes nol presume to give authonly lo violate or 4�ncel �. <br /> Ihe D'o��sion o/any olhe�stale or tocal law regulaling consimUion or t�c Oer/om�ance ol conslruction. Ttiat I am autnoniea Dy Ihe owner of t�is pmper,y '� <br /> to Oe rm Ue !or which aOD���alion Is made and 1 comDN'M�h I�e State CoNradors I aw 18 P RCW antl 298 200 WAC ',, <br /> •Df�. I <br /> �ner/Ar.innrizf�d Agent Signature Dato ' (Revise07R0f7) '. <br /> ���'� ,K. �wz D,�r aARR��� �� ' <br />