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i. <br /> PE T APPLICATION <br /> BUILDI GIMECHANICAUP MBING/SIGN/SPRINKLER/DEMOLITION <br /> �- OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPL�CATIONS ARE ACCEPTED FROM!AM TO�PM 4 a <br /> SITEADDRESS: PROPERiYTA%N P RMITI�D,3 • D <br /> i <br /> LEGAL lor new conalrucllon: Short PlaVsubdi on Lol No._ (attach copy of lonp lepal desuiplion) <br /> OWNER PhoneiE-meil S `J S <br /> Addresa Q CItylSlate2ip <br /> CONTRACTOR L 6 I Lia N <br /> AtlErese PhonelEmail <br /> TENAqT BUSINESS NAME CONTACT FOR PERMITQ _ /_ O�SO/� <br /> Vv Or� /3�� �.�,�. <br /> PhonelEfnall �,S' I <br /> BUILDIN6 PERMIT APPLICATI CONTRACT PRICE OF WORK <br /> Existing Use ot Building HEAT SOURCE: <br /> Proposed Use of Buiiding Gas Electhc Other <br /> Building type: _Singie Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Typeofprojed: _�ew _Addilion _Remodel _Repair_T.I._Sign_Sprinkler olition_Chenge ofUee <br /> Descrip�ion of Work(addifionel space provided on fhe back): ' <br /> G�t�s � „� u�-� �-e-��� �'�5;0�1 <br /> Have you sWrted working without a permit4 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa o1 ProJeel: _New_Addn _Alteratlon_Repalr Type of ProJect: _Naw_Addn _Attaretlon_Repair <br /> Show Num6er(M)ol fixturea Show Num6er(NJ o►flxfurea <br /> A/C—airhandlin units Toilet <br /> Forced air s slems Balh�ub <br /> Gas i in Lavato wash basin <br /> Waler heater Shower <br /> Gas fireplace Kitchen sink 8 dis osal <br /> Gas range Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Ezhaustfan Sink(service/bar/mo /elcJ <br /> Heat pump Backllow reventer <br /> Unit heater Urinal <br /> 8oiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medicai Gas <br /> SPRINKLER /SUPPRESSION SYSTEM Olher: <br /> Number of Heads Other. <br /> I hereby certlfy Ihal l have read and examined Ihis applicaflon and k�ow lhe seme la be Irue and wrrect.All provlsions o(laws and ordinances poveminp <br /> Ihis type of work will be complied wilh whelher specified hercln or not.The granling of e pertnil does no�presume lo give authotily to vlolale or wncel <br /> Ihe provision ol any olher state or local law regulaling Cons�rucllon or Ihe pertormance of conslruction.Thel I am au�horized 6y the owner of Ihis propeAy <br /> to pertorm Ihe wotk for which applicalion is made and I comply vnlh Ihe Stale Contrectors Law 78.27 RCW anA 296.200 WAC 1 Iv <br /> t <br /> OwnerlAuthorized ABent Sipnature Dale (Revised7l10f 1) <br />