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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everethva org <br /> APPLICATIDN5 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: PROPERNTA%b P R <br /> z 3 C !�"� , , Iti'A 9�01 Z _5 . -�'1� Z -G02 <br /> LEGAL br n=w conslrudion: hort PlaVsubEivis�on Lot No._ (attach wpy ol long legal Eescriplion) <br /> OWNER <br /> •T�— � C-� Phone![-mail �Zjl �SS �J� `�,✓i\';..r`^ � . <br /> naaress ZQ-f5" /CZNc�. 6"� �1, 'i ' C�tYl5lateiz�v 1�(� .(L'l�� , 1��� i c'�' <br /> APPLICANT: / Owner _Ovmer'sAgenl _ContraC.or Contractor'sAgent _7enanlim�.iP�o.ye�eik�ofconKmnommeo�ermaa.Ma�or�e:;... <br /> CONTRACTOR 1 L&I Lic.# COE 8us.Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E�mai� <br /> BUILaINGPERMITAPPLICATION CONtRACTPRICEOFWORK <br /> Existing Use oi 6uilding HEAT SOURCE' <br /> Proposed Use of f3uilding Gas eiectric_ Otner_ <br /> 6uilding type: _Single Family ,_Duplex_Townhouse ,_Multi-Family _Cemmercial <br /> T pe of ro'ect: New Addition Remodel Re air T.I. Si n Sprinkler Demolition Chan e oNse <br /> DESCRIPTION OF WORK(atld�honal sp�ce proWtletl on fhe 6adJ: <br /> ����f�� %� (�, <br /> MECHANICAL PERMIT APPLICA7ICN PLUMBING PERMIT APPLICATION <br /> TypeolPro�ect: _New_Addn _A��eratlon_Repair TypeofProJec�: _New_Addn _Alleratlon_Repair i <br /> Show Num6cr(IX)ai liirfures Sbow Number(a/o!Odures <br /> P�C—air hantlling uniis Toilei <br /> Forced air s slems Bathtub <br /> Gas piping Lavatory pvash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink 8 dis osal <br /> Gas range Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood VJater heater <br /> Exhaust fan Sink(sernce/barlmopletc) <br /> Heat pump � 6ackflow pre��en,er <br /> Unrt heater Urinal <br /> �oiler Drinkin Founlain <br /> Refrigeration Floor drain <br /> Woodslove Grease tra <br /> Ductinq I Roof dreins <br /> � Other ldetlical Gas <br /> SPRINKLER I SUPPRESSION SYSTEh7 Other: <br /> Number of Heads Other <br /> I hereby cerirty Ihal I heve rced end esemineJ Ihis upplicalron ana Anc.v fAa samc lo�e Uue and eorted.AA pmvislom ol levn end orEinancee goveminp I�la rype ol work vnl be compFeA <br /> viAh whethtt spetlfied he21n or nol.iM prnn�ipp ol e pem�A tloef nol presume to pNe auNorlly to violale o�cancel Ne proNfbn ol eny aNer slsla or local L�r,repuletb0 conslrvdlan <br /> ihat I am euNotl:ad 6y Ihe oWner ol Nlf propetty lo pedorm 1he wor4lor whkh ePFkelbn�meCa anE I compy wih tl�e Slela ConlratloA Law 7 8.17 RCW enE 2BB.20DA WAC. <br /> � �2=�-.-- _ ll�'�a�'i� <br /> ovmerlAulhod gent Slgnelura Date (Revised W201P) <br />