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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—F,4X 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: ��Zl /`�I) � {� .���il � PpOPER7YTA%p PERMITN <br /> L i (���e.�� U C- <br /> LEGAL for new conslmclion: Shotl PlaVsubtlivision(� '� 17t1 T�4�" �`�� �-��l•FLo1 No.�.1�L(allach wpy ol Iong legal description) <br /> � ✓ <br /> OWNER \h. � ( ( Phone/E-mail (/ ; <br /> Aed�ess �7 � CIIy/SlatelZip 'c-� <br /> CONTRACTOR L&I Lic.# <br /> Adtlress Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �`(�(; <br /> 11IQ(] � �/��C <br /> Phone/E-maIIVU l "���'� �rC����7 1 I `�"� "' ? <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WOR ����4(J�� <br /> [r.isting Use of Building HEAT SOURCE: <br /> ProposedUseotBuildinq� � iC�ro ��FRLP Gas_ [iec�dc otner <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projed: K New _Addition _Remodel _Repair_T.L_Sign_Sprinkler_Demolition_Change of Use <br /> Description a(Work(edaifionel.:pace provided on(he beckJ: <br /> Have you started�vorking wilhout a pertntti _YES/�NO <br /> MECHANICAL PERMIT 4PPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Projoct: _Now_Addn _Alterallon_Ropair Type ol ProJect: _New_Addn _Alteratlon_Repalr <br /> Show Number(M)ol lixrores Show Number(M)ol flxrores <br /> A/C—air handling unds Toilel <br /> Forced air systems �athtub <br /> Gas piping Lavatory Iwash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas ranae Dishwasher <br /> Clotnes d er Clothes washer �I <br /> Range hood Water hea!er <br /> Ezhaust lan Sink(servlce/bar/mop/etc.) <br /> Heat pump l3ackflow prevenler <br /> Unil heater Unnal I <br /> Boiler Drinking Fountain <br /> Refri eration Floor drain ' <br /> � Woodstove Grease trap <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM otner: <br /> I � NumberotNeads I Other. <br /> I hcmby cenify ihal I have reatl and examined Ihis apPlicalion and know the seme to be irue and wrrect.All provlsions of laws and oMinance6 goveming <br /> lhis type of work will be complied wilh whether 6pecified hereln or nol.The grantlnp of a permit does no�presume to give authodty lo violate or cancel <br /> the pr�YIsion of any other stete or local law regulaling conslrudlon or lhe peAormance o1 conslructbn.That I am aulhor¢etl by the owner ol this propedy <br /> to peilptp'�he wor�. , i�h epplicalion is matla and I eomplywilh Ihe Sta(a Conlroclo�s I.a�•�1027 RCW and 298200 W�C <br /> \ � I <br /> ,. �.: I <br /> Own / u e Agen[Si� gnetura .��at" (Reviaed22011) �l� <br /> � <br /> ( <br />