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� �_ <br /> PERMIT APPLICATION <br /> BUILD�ING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES g•-3(..�' <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE '�DR P a RD pjoZ OO�Oa� PEft �IDO � <br /> O O EII�r' .� <br /> LEGAL for new construclion: Shart Pletlsu6division Lot No._ (ettech eopy of long kgel desuiplion) <br /> OWNER �0. O'� V PhonelE-m.�� <br /> Address �� p Q/ �!' CitylStelelZip C+P W �d <br /> CONTRACTOR � L 8 I Lic.# � � <br /> Address � w 3 PhonWEmail Z,S `� �b <br /> TENANT U INE33 NAME CONTACT FOR PFRMIT ��S 9�2 �2 d D <br /> ,M C N1 ��N412 �� O�,y� <br /> V ' \a2 0 ` �'� PhonelE•meil �A1 W1 <br /> BUILDING PERMIT APPLICATION coNTRncT aRICe oF wORK �• "� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Usa of Building ces_ Eledric Other <br /> Building lype: _Single Family _Duplex,_Townhouse _Multi-Family _Commercial <br /> Type of projed: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> Description of Work(additional space provided on fhe beck): <br /> Have you ataRed working without a pertnit7 _YES NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type oi ProJect: _New_Addn _Alteratlon_Repalr Typa o1 ProJect: ,_New_Addn _AltenGon_Repalr <br /> Show Number(M)o/Iixtures Show Number(N)o/(lxtures <br /> A/C—airhandlin unils Toilet <br /> Forced air s stems Bathlub <br /> Gas ipin Lavato (wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br />� Clolhesd er Ctotheswasher <br /> Ran e hood Water heater <br /> Exhaust fan � Sink servicelbar/mo letc.) <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floordrain <br /> Woodstove Grease tra <br /> Ducling Roof dreins <br /> Other Madical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> Number of Heads Other. <br /> I hereby ceAiry that I have read and examined this app�lcation a�d know the same to be true and coneci.IUI provis(ons of lewa and ordinanees govaming <br /> this type of work will be complied with whether speci�ed herein or not.The granting of a pertnit does not presume to glve auMoriry lo vlolate or cancel <br /> the p vision of any other slate or local law regulating construelian or ihe pnriortnence of construction.Triat I am authorized by the ovmer of this propeAy <br /> to orm the work to ich application is mede and I comply wilh e Slete Contrectors Law 78.27 RCW and 298.200 WAC <br /> �'� . G � � 1 � <br /> dAulhodzadAge tSipnatu D le (Revised22011J ,� <br />