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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St , Everett, WA 98201 - 425-257-8810 - FAX 425-257-8857 - www everettwa or <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM d (x - O 3 <br />SITE ADDRESS: <br />PROPERTY TAX <br />Rao 6•t <br />LEGAL for ne/w Shod PIa0m00msion.5Ni7c�rs-,-[cS 2d Lot No riUZ. (attach copy of long legal desonphon) <br />7�construdion <br />OWNER L./�•cr,2ErPhone/Email <br />y7 -_ 0_ <br />nddmss pi C� <br />citylslalelzip a20 / <br />CONTRACTOR fc <br />L 6 I LIc N <br />Address jsl� Phone/Email j •a/� _�/S� - - — <br />TENANT BUSINESS NAME <br />CONTACT FOR PER IT CiLEnls% C+dG C7 <br />Phonelil-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Expsbng Use of Building •a .1%lige' . HEAT SOURCE. <br />Proposed Use of Building�,vL'gG€ Gas Elecbk Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project: _r New _ Addition _, Remodel _ Repair T I _ Sign,Sprinkler _Demchhon Change of Use <br />Description of Wotk (addthenat space pmwded on tee beta) ' <br />Have you started working without a permit? _YES ✓ NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number ) of nrtures <br />Type of project: _New _Addn _Alteration _Repair <br />Show Number (01 of ffrruna <br />I A/C - art handling units <br />I Toilet <br />Forced air systems <br />I Bathtub <br />I Gas piping <br />I "' aid wash basin <br />Water heater <br />Shower <br />Gas fireplace <br />I Kitchen sink d disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />_ <br />Clothes washer <br />Range hood <br />_ <br />Water heater <br />Exhaust ran <br />Sink (servicelbar/m0 talc <br />Heal um <br />_� <br />BackRow preventer <br />1 Unit heater _ <br />_ <br />Urinal <br />Boiler _ <br />Refrigeration <br />_ I <br />—� <br />DZ1 ri Fountam <br />Floor dram <br />_ <br />i Woodslove <br />_ <br />I <br />Grease trap <br />I Circling <br />Other <br />I <br />Roof drains <br />I <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other. <br />Number of Heads <br />Other. <br />1 hereby cemly that I have read end examined this application and know the same to be true and cared. All provisltns of laws and oldmances governing <br />this type of work will be complied with whether specified herein or not The granting of a permit does not presume to give authonly to violate or cancel <br />the provision of any other state or local law reguistmg construction or the performance of construction. That I am aulhorired by the owner of this property <br />to perform the 1 whj ap ion i ado and 1 comply with the Slate Contractors Law is 27 RCW and 299 200 WAC <br />OwnerTkuthbrized Agent Slgn - Dale (Revised 212011) <br />