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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGlSIGNISRRINKLERIDEMOLITION <br /> CITY OF EVERETT" PERMIT SERVlCES <br /> 320Q Cedar SL, Everett, WA 98�01 -425-257-8610- FAX 425-257-8857 -www.everetN�a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5- � �I <br /> SITEADDRESS: •� , '' � , . ' _ PROPCRNTA%a PE�iMITp <br /> - L-�! 1%Y4dCt ��%lit-�- .JI �(.'c - �. <br /> LEGAL for newconstmcilon: Short PlaVsubdivision .__ .. _. ._ __--.-�ct IJo . . __ �altach wpy ollong legal description) <br /> OWNER� .l,i�(� 'i` i. "'� �P"�r � PhonelE-mail <br /> � 1 ') / <br /> Adtlress '� 1/i�( Y -��l C.,���L(• , j� (C.J� City/State/Zip �. ' �!-��' �: ' � ' <br /> CONTRACTOR I '. /�� ��.Q, l,/1 ul-f, ��'- L81Lic.N -`-�'i-".� ' Ci��� <br /> ✓i, . , _ t > � c7`-� 7 "'--7J <br /> Address i�.,/(���i - '; l�'�-�/��i/l� L�.C7� ��/!��i'('��-j`�� .Yc.Uj PhonelEmail �f��� / /lii.6(�J� <br /> TtNANT BUSINESS NAME CONTACi FOR PERMIT ���.i��` �.: �`.:�� .(�I <br /> .J <br /> ��)_. I�i� _ Phnrie'c-mail � ' � �/. �.;5_.� � �. <br /> BUILDING PERMIT APPLlCATION coNTw.CrPaiceoFwoRK_!-:�,__�-� ____ <br /> Existin Use af Buildin _ ___ HEAT SOURCE: <br /> 9 9---------- -------- - <br /> ProposedUseofBuilding____________ �as____ E�ectric____ other____ <br /> Building type: __Single Family _Duplex_Townhouse __�Muili-Family�Commercial <br /> Type of projecC __New ._Addilion _Remodel __Repair__T.I.�Sign__Sprinkler___Demolition___Change of Use <br /> Descriptioq of Work(adCd�anal space providad on fhe 6ackJ: <br /> r� -,�,. <br /> `� :��� !/ { � j (/l) (��C�%� �1 �� 7.�' <br /> ,C{ ! <br /> Have you started working wilhout a permit7 ____YES _��..NO <br /> MECHANICAL PERMIT APPLECATION PLUMBING PERMIT APPLICATION <br /> TypeolProjecl' ._New __.Addn _Alterathn __Repair TypnolProJecC ... New___Addn ___Alteration__.Repalr <br /> Show Number(p)o/firfures Show Number(p ol lixfures <br /> NC-�+ir handlinr dnits Toilet <br /> � Farced air s s�ems Balhtub <br /> � Gas pipin � Lavalo wash basin <br /> � Water heatet ' Shower <br /> � ' uas fire la✓� ' Kifchen sink 8 die osal <br /> � Gasranoa ' � Dishwasher <br /> ' I Clothes Crver i '� Clothes washer <br /> � Ran �;hood Water heater <br /> I Exh��usl fan � � Sink(servicelbarlmo letc. <br /> !� ' Heatpum i 8ackflow reventer <br /> Urvt healer � Urinal <br /> ��11z, �rinkin Fauntain <br /> � Refri eration i I Floor drain <br /> '� Woods�ove Grease lrap <br /> I Ductin I Roof drains <br /> I Olher_____ Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM ' otner. <br /> i <br /> Number of He�ds I Other: <br /> 1 hereby cetlih that I have read and examined Ihis application and know the same to be true and wrrecl.All provisions of laws and ordinances goveming <br /> this type ot work will be complied with whelher specified herein or not.The granting ol a permit tices nol presume to give aulhonty to violate or cancel <br /> Ihe provision of any other state or loca�law regulaling construction oi the pedormance ot wnstruction.Thal 1 am aNhorized by the owner o1 ihis property <br /> to ppr(orm�.te vrork tor which applicalion is rnade and I comply with 1he Stale CoMractors Law 7827 RCW and 296.200 WAC '/ <br /> / � ' � �7 .:;j�,i=_- � ; 7 y�"'� S� li <br /> ����j G�Y"� `J <br /> Ownur.A thorize AgentSlgnalure Date (Revised212011) <br />