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C � <br /> PERM17 APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.evere .org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM 0 a'Z7 �� <br /> SITEADDRESS:�� �J� PXOPERTYTAXII PERMIT�r/// ., <br /> L(/ �> <br /> LEGAL la new wnstruction: Short PlaVsubAivision___ Lot No.___ (attach copy ol iong legal dascription) <br /> OWNER J � (�(� PhonelE-mail <br /> Address Ciry/Slale/Zip T T— � C1 <br /> CONTRACTOR / (l� L 81 Lic.# � <br /> Address ��v p� � �.� 1'� 1 ' `Q"� VW I la honelEmail �z �� <br /> TENANT BUSINESS NAME CQNTACT FOR PERMIT-t7�� f�(�:'�. <br /> � I,vt Ct , � � ����. <br /> PhonelE-mail <br /> BUILDIN6 PERMITAPPLICATION CONTw4CTPRICEOFwoRK� ' — <br /> Existing Use of Building __ HEAT SOURCE: <br /> Pmposed Usa of Building Gas__ Eiectnc___ Other__ <br /> Building type: __Single Family _Duplex__Townhouse _Mulli•Family �Commercial <br /> Type of projecl: �New _Addition _Remodel __Repair_T.I.�Sign�Sprinkier_Demolition_Change ot Use <br /> DeSCriplion Ot W ork(addifional spece provided on Iha back): <br /> (iY�S�Zi.2n Gl�,e �G�� s�Jv� <br /> Heve you slarted working without a pertnit7 __ YES _NO <br /> MECNANICAL PERMIT APPLICATION PLUMBIN6 PERMIT APPLICATION <br /> Typa ol Prpjact: __Naw_Addn _Alhrallon_Rapalr Typa of Propat: __Naw__Addn __ Ak�rNlon_R�pair <br /> � SAow Number(K ol flrturas Show NumWr t oI flrNns <br /> AIC–airhandlin unils Toilet <br /> � Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Waler heater Shower <br /> Gas fire lace Kilchen sink 8 dis sai <br /> Gas ren e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood Water healer <br /> Ezhaust lan Sink servicelbar/mo lelc. <br /> Heat um Backflow reventer <br /> Unit heater Urinel <br /> Boiler Drinkin Fountain <br /> Refri eralion Floordrein <br /> Woodstove Grease tr^o <br /> Ductin Roof dro <br /> Other_,____�___ Medical Gas <br /> SPRIIiKLER/ SUPPRESSION SYSTEM otner: <br /> � Number of Heads Olher: <br /> I hereby certify that I have read and ezamined this appliwtion and know the sama lo be true and correct.All provisions ol laws and ordinances goveming <br /> this type of work will be complied with wfiether specified herein or not.The gran6ng ol a permit does not presuma to give aulhodry to violate or cancel <br /> the pro ision of any other state or�ocal law regulating constmdion w the peAormance ol wnstruction.That I am authwized by the owner ot this property <br /> lo ped� i tl v,orl;for which eppiication is made and I comply v.ith ihe State Conlreclors Law 78.27 RCW and 296.200 WAC <br /> ; ; � y <br /> OwnedA o zadAg tSlgnaluro Dale (Revised?12017) <br /> i � v <br />