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( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALlPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.evcrettw .org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �b /Z � <br /> SITE ADDRESS: PROPERTY TAX N P M�T� 0 .00� <br /> ��U " � �.�i� an��W4' <br /> LEGAL for new consiruclion: ShoA PlaUsubdivision Lot No._ (altach copy ol long legal descrip�lon) <br /> OWNER C' — �-�'I PhonefE-mail <br /> Address Cily/S�alelZip <br /> coNrancroRTl��. rl�t,, •� � n L&1 Lic.# �O D �*' S S <br /> Address �(�, � i ��� ` I��UL i�. �Lli�lo".� '"f�l�J Phone/Email yz�uZ�' s � <br /> TENANT BUSINES$NAME CONTACT FOR PERMIT <br /> I �, / ���t.c,d,—s� <br /> /li-. /�f PhonelE-mail <br /> BUILDING PERNf11' APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of B�ilding HEAT SOURCE: <br /> Proposed Use of 8uilding Gas_ Eleclric_ otner_ <br /> Building type: _Single Family _Duplex_Townhouse _Mulli•Family _Commercial <br /> Type of projecl: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> Description o/Work(addifionel apace provided on fhe back): <br /> Have you started working wfthout a permitl _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypootProJect: _New_Addn _Alteration_Repair TypeofProJecl: _New_Addn ✓Alteralion_Repair <br /> Show Number(N)ollixtures Show Num6er(N)o/flxfures <br /> A/C—air handlin units Toilet <br /> Forced air s s�ems Balhtub <br /> Gas piping Lavalory(wash basin) <br /> Waler heater Shower <br /> Gas lireplace Kitchen sink&dis osal <br /> Gas range Dishwasher <br /> Clothes d er � Clolhes washer <br /> Range hcod Waler heater <br /> Exhausl fan � Sink(servicelbadmop/etc.) <br /> Hea�pump BackOow preventer <br /> Unil heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drein <br /> Woodstove Grease tra <br /> Ducling Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined Ihis applicatlon and know Ihe same lo be tnie and wrtect.All Frovislons of laws�nd ordinances Boveming <br /> this lype ol work will ba complied with whether specified herein or not.The granling of a permit does not presume to give authrn�y lo violate or cancel <br /> the provision of any olher stale or local law regulalfng conslruction or Ihe periormance of construction.Thal I am authorized by the owner ol lhis property <br /> to peAorm Ihe work for which applicalion ia made and I comply wilh the Slate Contractors Law 78.27 RCW and 296.200 WAC <br /> �j�� `/?*�� (o�i��i/ <br /> Oy/qfrlAuthodzodAgant5lgnature D te (Revised7R011) <br /> v <br />