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( <br /> � PERMIT APPLICATION <br /> BUILDINGIMECH/�►NICAUPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St.,Evereri, WA 98201 -425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM <br /> SITE ADDRESS: ���� � VROP R3 M � � � P RMZOS_�L <br /> J <br /> LEGAL lor new construction� Shorf PlaVsubdivisian_ Lot No._ (atlach copy ol long legal description) <br /> OWNER S ' ,(/ PhonelE-mafl <br /> AGdress � , I�� Ciry/Stale2ip �/{�f.� �� <br /> CONTRACTOR � � ic.# + ' <br /> Adtlress Phone/Email � � � � <br /> TENANT USIN S N E CONTACT FOR PERMIT <br /> � (��J,� Phane/E-mail L � ���� J�/�, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK� ,�'� _ <br /> Exisling Use of Building_ HEAT SOURCE: <br /> Proposed Use of Buitding _ Gas____ Electric___ Other___ <br /> Building type: _Single Family _Duplex_Townhouse _Mulli-Family �Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.1.�,Sign_Sprinkler_Demolition_Change ot Use <br /> DeSCripfi0n of Wofk(addi(ional space provided on the backJ: <br /> � �S��' G;�-e... �v-��i s�ru,,,, <br /> Have you started workinp without a permlt? _YES u_NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLLCA'TION <br /> Typa ol Pro�ect: __ New__ Addn _Alterdlon_Repalr Typa of ProJacL• ___New__AdM _Altentlon,_Rp�b <br /> SAow NumMr N o/Nrfuns Show Number RJ oI Rrtuns <br /> A/C—air handlin uMts Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water healer Shower <br /> Gas fire lace Kitchen sink 8 dis sal <br /> Gas ren e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink sarvicelbar/mo letc. <br /> Heat um Backflow reventer <br /> Unil heater Urinal <br /> 8oiler �rinkin Fountain <br /> Reiri eration Floor drain <br /> Woodstove Greasa tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESEION SYSTEM Other. <br /> Number of Heads Other: <br /> I here6y certily Ihal I have read and eKamined this application and know the same to be true and wnect.All provisions al laws and ordinances goveming <br /> this type of work will be complied with wfiether specified hereln or noL The granting ol a permit does not pres��me lo give euthority to vidate or cancei <br /> the provision of any othet stata or lowl law regulating wnstruction or the peAormance ol wnslrudion.That�am euthodzed by Ihe ovmer o1 this property <br /> 1 e work for which appliwtion is made and I comply wlth the Slate Cont2dors Law 18.27 RCW a id 296.200 WAC / <br /> � /'��". �7���Z 1 Z <br /> w IAuthor zed Apent Sipnatun �ate (Revlsed 7I2011) <br />