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{ <br /> PERMIT APPILICATION <br /> BUILDING/MFCHANICAUPLUAABIRIGISIGiV/SPRIMKLER/DEMOLlTION <br /> CITY OF EVERt?TT PERMIT S{=RVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-257-8857-www.evere".twa(,.org <br /> APPLICATIONS ARE ACCEPTED FRONI 8 AM TO 4 PM �1"'�9 `� <br /> PROPERTYTAXN P MIT• /Tl <br /> SITE ADD S : �� ��O4— `'��� <br /> i o�I�Z �Ue �- 1,�,- <br /> LEGAL for new conslruction: Short'rlaVsubdivision Lot No._ (allach copy ol long Iegal deseriplion) <br /> OWNER l�p�`/ ��� r u D-• Phone/E-mall <br /> Address /b,�/Z- C�n �- 7�w`t GIIyISlatelZip _ <br /> CONTRACTOR IL� S�SK�ti L 81 Lic.# <br /> Address �/ �U� I� L .J �� �L C��+�— PhonelEmail Z � Sb �- 6 yy <br /> TENANT BUSIkESS NAME CONTACT FOR PERMIT <br /> �/q U� �� �(�[f� r Phone/E•mail c�y�. We-��5s <br /> i��� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK S4 _. <br /> HEAT SOURCE: <br /> Existing Use of Building — <br /> Proposed Use of Building Gas__ Eler.tric_ O�her_ <br /> Building type: _Single Family _I)upler_Townhouse _Multi-Family _Commercial <br /> Type of projecl: _New _,Addition _Remodel _Repair__T.I._.Sign,�Sprinkler_Demolition_Change of Use <br /> Descriplion of Work(eddifional space provided on the 6ack): <br /> Have you staRed working wlthout a permit4 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeoiProJect: _New_Addn _Alteration_Repair 7ypeofProJeot: _New_Addn _Allerotion_Repair <br /> Show Number(N)o//fxtures Show Number(M)o/flxtures <br /> A/C—air handling units Toiiet <br /> Forced air systems Balhtub <br /> Gas pipin Lavatory(wash basin) <br /> Waler heater Shower <br /> Gas fireplace Kilchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Range hood <br /> Waler heater <br /> Exhaust fan Sink(servicelbar/moplelc.) <br /> Heat pump BackFlow prevenler <br /> Unit heater Urinal <br /> Boiler Drinkin Founlain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting <br /> Roof drains <br /> Olher Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEM Other: <br /> Num6er of Heads Other: <br /> I hereby certify Ihat I have read and ezamined this application and know lhe seme to be Irue and correct.All provisione of laws and ordinances goveming <br /> this typa of work will be complied with���hether specifed herein or not.Tho grenting of a pertnil does nol presume to give authnnty lo violale or wncel <br /> the provislon of any other slate or local law rtgutalin9 cons�ruction or the perlormance of conslruction.That i am authorized 6y the owner of lhis property <br /> to peAorm the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> �,�' � ��.�� G� �9-�� (a <br /> OwnerlAut rized Agent Slgnature <br /> �ate (Revised7/2017) <br /> � <br />