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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-BS57 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �a� - �3 <br /> SITEADDRES�• Paorenivinxa PE ilT��,� <br /> � I <br /> .t_ 7 t"t �dl' <br /> LEGAL lor new cons ruclion: Shod Plausubdivision lol No._ (ettach copy ol long legal descriplion) <br /> OWNER Phone/E�mail - (, - ' � <br /> ntldress , z) Ci'�b ✓' Crty�Staie2�p y '/ $ �1 <br /> APPLICANT:_Owner Ovmer'sngem CONranor Con!rectorcAgenl Tenant�m�.�e���+a.,�:mrcimnnmo-omm.w.�.<<�eo+on�,m..c+�i <br /> CONTRACTOR - L�G L&1 Lic.# r I� CT'i COE Bus.Lic.# <br /> nc�ress r��- 1I I ? �'t i - ( � � Z Phone/Email ��ZJ ' ! 2U � � DL-i.�m <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ��FiU S/�f��l <br /> � ', �''{'� P�one/E�mail N�,. `.3 J--v���l <br /> BUILDING PERMIT APPLICATI�N CONtRACT PRiCE oF WOR1�7,7�C,n _ <br /> EzisUng Use of Building i rs�'j�1�� HEAT SOURCE: <br /> Proposed Useof Ouilding �+�'�'��-)� Gas Electric _ Omer_ <br /> Buildingrype: _SingleFamily _Duplez_Townhouse _Multi-Family _Commercial <br /> T pe of pro ecC New Addition Remodel Re air T.I. Si n y Sprinkler Demolitian Chan e of Use <br /> DESCRIPTION OF WORK(aedi��onai:pace pro��ded on the qactr): � <br /> -r_l. li- ne'+u�x ���'-'�•n�.iti Iu,tl� �35 � utitii G2HK�. {�.s�i�A� Q..ul{ �e�a iu�b�i e�! ,m�.uG.l �l�Z ix�ea- <br /> CE.)�ftt� k�SL� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypootProJocl: _New_Addn _Alturalion_Repalr TypeolProJecl: _New_Atldn _Allerallon_Repalr <br /> Show Number(aJ ol lixfures Show Numbcr(p)of Atlures <br /> FVC-airhantllingunAs I Toilet <br /> Forccd air systr,ms 8alhiub <br /> Gas pip�ng Lavato (wash basin) <br /> Water heater Shower <br /> Gas fire lace Kitchen sink 8 disposal <br /> � Gas ran e � Dishwasher <br /> Clothes dryer � Clolhes washer <br /> Ranqe hood Water heater <br /> [xhaust fan Sink(service/barlmopletc.) <br /> Heal pump � Backflow preventer <br /> Unit heater Urinal <br /> Boilcr Drinkin Fountain <br /> Refrigeralion Floor drain <br /> Woodstove Grease Ira <br /> � Ducting Roof drains <br /> � Other �9edical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> ; ,) Number of Heads Olher. <br /> t hmeCy cmtRy��al l ham iend on0 c�amhed I�ie opplicnlion enC knaw Ne eamo to be lrue an0 co�red.Atl p�orisiana cl lmve anA ortlnencee govemb0 Na rype of wwk wd bo comp6etl <br /> v:�9nvnelher eDeGlmtl�ercim m�oL Tha p�entln9 0l a Ocrmll Aoaa not pmsume lo pHe auttiotlty lo WaWte or cencel t�e pro�isbn of any oNer slate or local law re0uWlinp mnsimcuon <br /> 7 hal l am Dut�otlxe0 Ey lln ownef o11�if pmpeM�o pedorm t�o work for xTk�epP�����msEe enU I comDN w�M1 No Stete ConUadon Law 1 B.t7 RCW end t88.700A WAJ. <br /> l i �u�n�1�� Z�7�o1 ��� <br /> Owner/Authorized Agent Signelure �ate (Revised 6/2012) <br />