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� <br /> PERMIT APPLICATION <br /> BUILDING/MECHaNI(:ALIPLUMBINGISIGN/SPRINKLER/DEIVIOI,ITI N <br /> CITY OF EVERE'fT PERMIT SERVICES l( � y <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettw .org C, <br /> �' S 3 O APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �I I I —� ✓ <br /> SITEADDRES PROPERiYTAXp PE�T� _ S <br /> Gl�Pi3- .�e-� GV <br /> LEGAL lor now conslruclion: ShoA PlaVsubdivisian L�I No._ (aUech copy of Ion81e9a1 descriplion) <br /> OWNER � D�-� �"�^^— PhorWE•mail <br /> Address �5� �✓' �°'�'� W CltylSlale2ip (�jl/�P/1"R-� w�1 7�7�tF <br /> CONTRACTOR W I.t� ,2 "! ` L 8 I Lic.# (N N l 7��z 7 6 C J <br /> Addross �/ ( O � �'( � � �i/�� l�h Woo � PhonelEmall — `��j —J�J 6� <br /> TEKANT BUSINES5 NAME ONTAC FOR PERMIT !� .�� <br /> j�� <br /> ',�? ��.�� ���� ���� PhonelE-mail <br /> BUILDINGPERMITAPPLICATION CON7RACTPRICEOFWORK ' �— _ <br /> Existing Use of Building HEAT SOL'RCE: <br /> Proposed Use ot Building Gas_ Electric Oiher_ <br /> Buildinglype: _SingleFamily _Duplex_Townhouse _Multi-Family _ ommercial <br /> Typeofproject: _New _Addition _Remodel _Repair_T.I. Sign Sprinkler_Demolition_Change otUse <br /> Description of Work(additional space providedon the back): <br /> Tlis�al( ��i�'��hR1L S�-�^-( . L�,p �(l�„�,.�.•.t.�� . <br /> Hav¢you slarted working wilhout a pertnit? _YES NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofProJoct: _Now_Addn _Alloration_Rapair TypoofProJect: _Now_Addn _Altoratlon_Ropalr <br /> Show Numbcr(q)o!fixfures Show Numbrr(pJ o/flxturcs <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Oishwasher <br /> Clothes d er Clothes washer <br /> Range hood Water healer <br /> Exhaust(an Sink(servicelbadmapletc.) <br /> Heat pump Backtlow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Founlain <br /> Refrigeration Floor drain <br /> Woodslove Grease trap <br /> �ucting Roof drains <br /> Olher Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEM Other. <br /> Number of Heads Other. <br /> I hereby certify that I hava read and examined Ihis appilwtion and know tha same lo bo lruo and correct.All pravisions ol laws and ordinances goveming <br /> lhis�ype of work will be wmplied with whether specified herein or nol.The granting of a pertnit does not presume to give aulhcri;y to violate or cancel <br /> tho provisfon of any other state or lowl law regulatfng wnslrucllon or the perfarmance ol cons�rucllon.That I am authorized by Iha ovmer ol lhis propeAy <br /> to peAorm Ihe work(or whlch appliwlion is mede and I wmply wilh the State Canirectore Law 18.27 ftCW and 296.200 WAC <br /> (���L� ( r/��r i �i� <br /> OwnorlAuthorizodAgont5lgnal ro Date (Revised712011) <br />