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1 � I <br /> PERMIT APF�ICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evetett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDR 55: n . �� . �� ( PftOPERiYTAXM P �T/� —OO <br /> 17 <br /> LEGAL for new wnsirudion: Short PlaVsubtllvision Lol No._ (atlach copy ol tong legal descripl lon) <br /> OWNER yr-+�G�.� IN��� PhondE-mall <br /> ddress CltylStalelZip <br /> CONTRACTOR � � L 8 I Lic.# <br /> ddressy3ao "' � rii`��TIZWQ /� PhonGEmail �C�� p�7'�7� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phon�JE•mail ��" ������"' ad�)8�7'��� <br /> BUILDING PERMIT APPLICATION coNTRacTrRlcEOF WORK <br /> F,cisting Use of BuiWing HEAT SOURCE: <br /> Proposed Use of Buildfng Gas_ e�ec�dc Other <br /> Buiidingtype: _SingleFamiiy _�uplex,_Townhouse _Multl•Family _Commercial <br /> TypaoFproJed: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler__Demolilion_Change olUse <br /> Description o(Work(addifional space provfded on the baclQ: <br /> � r� .��?�� �v�-f� l <br /> Have you started working wilhout a permit7 YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typao}ProJact: _New_Addn _Alleration_Repalr TypeolProject� _Naw_Addn _Alteralion_Repeir <br /> Show Number(M)ol Rxtures Show Number(NJ o!lLHures <br /> AIC—airhandlin unils Toilet <br /> Forced air s stems Bathlub <br /> Gas i In Lavalo wash basin <br /> Waler heater Shower <br /> � Ges fireplace Kilchen sink 8 dis osal <br /> Gas ran o Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran a hood Water heater <br /> Exhaustfan Sink servicelbar/mo /etc. <br /> Heat um BackOow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refn eralion Floordrain <br /> Woodslove Greasa lra <br /> Ductin Roof drains <br /> � Olher Medical Gas <br /> SPRINKLER/SUPPR'eSS10N SYSTEM Other: <br /> Number of Heads I Other: <br /> I hereby certify Ihat I have read and examined this appliwticn and know Iho same to he true and cortect.All provislons ol laws and orCinances goveminq <br /> this rype of wo�C will be complied wilhwheth r specifetl herein or nol.7hu granling ol a permit dces nol presume to give auNonty to violate or wncel <br /> the prov n ol eny other slale or local la regulatinp const�uction or 1he pe�tortnanw of eonsWction.That I am aulhorfzed hy l�e mmer of Ihis pioperty <br /> lo pe tho xork fw which aall s mede and I comply with the Slate Contreclors Law 18.27 RCW and 288.200 WAC <br /> $ / /L <br /> O nerlAutho ure �a!e (Revised 7/2011J <br />