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� PERMIT APPLICATION <br /> BUI�DINGIMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CIN OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,W A 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: PROPEaiYiaXH�,��Z,L PEiMT�_OD <br /> �0 �1 •V <br /> LEGAL for new construction: Short PlaUsubd�vision Lol No._ (a�lach copy of long Iegal description) <br /> OWNER Phone/E-mail <br /> Address �Va" I.J T�f City/State2ip Q i (�t� �lC •r 3 � `] <br /> CONTRACTOR L/1 V�� °'— L&I Lic.# �.3 <br /> Address ` �3U I��� � !/�[ �D rl/p /6 Phone/Email � i" !2Z <br /> TENANT BUS NESS NAME CONTACT FOR PERMIT ���f�L.r{.=yapp <br /> Itp(j6y W��;V PhonelE-mail �Z� � ^`��-�l K� � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1Z� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Buiiding cas_ Eiect�c_ O�her <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Type of project: _New _Addilion �Remodel _Repair,_T.I._Sign_Sprinkler_ Demolition_Change of Use <br /> Descriplionof Work(addifionalspaceprovidedonfheback): ��U�4L.4- FGkIND/(d� �yJP_ (��'A� � S/l,f:c- �Cu�w�Ei. J'` EXr�/avy BG� <br /> Have you started worktng without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATlON <br /> Typeof Ject: _New_Addn _Alteratlan Repalr TypoofProject: _Naw_Addn _Alteration_Reyalr <br /> ShowNum6er(!i)offlxfures ShowNum6er A o111xtures <br /> AIC—airhandlin nits Toilet <br /> Forced air s st s Bathlub <br /> Gas ipin Lavato wash basin <br /> Water iie r Shower <br /> s fre ace Kitchen sink&dis osal <br /> Gas e Dishwasher <br /> Clo e d er Clothes washer <br /> n e od Water heater <br /> xhaust t 3 Sink servicelbar/mo letc. <br /> Heat um Backtlow reventer <br /> Unit heater Z Urinal <br /> Boiler � Drinkin Fountain <br /> Refri eration Floordrain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> � Other I�-raP{L� /F'UI.�iG. InNNS Medical Gas <br /> RINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby ceAi(y that I have read and examined this applicalion and knowlhe same to be irue a�d conecl.All provisions of laws and ordinances goveming <br /> Ihis�ype ot work will be complied with whelher specified herein or nol.The granling o(a parmit does not presumo to give authority�o violale ar cancel <br /> ihe provision of any olher state or local w regulaling conslruclian or Ihe performance of conslruclion.Thal I am autForized by ihe ovmar of this property <br /> �o pedorm t work for which applicalion Is ade and I comply�Mth Ihe State Conlraclors Law 18.27 RCW and 29620�WAC � ���� <br /> 1,\�1�'� <br /> OwnnrlA r zed Agent-Signature - � Date (Revised 22011) <br />