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( � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Ev=rett,WA 98201 -425-257-8670—FAX 425-257-8857—www.everettwa.org <br /> ppPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3`'�..6 I z <br /> SITE ADDRESS: PROPERiY TAX p PER�TO -O�7 <br /> � N VJ2 J <br /> LEGAL lor new conslNction: Short PIat/5ubdivision _Lol No._ (altach copy oi long legal description) <br /> OWNER Phone/E•mail <br /> ddress CltylSlate2ip <br /> CONTRACTOR y`Ah k ��Y't- L&I L(c.# �i�an {'t a- � 2� GU <br /> nadres5 S o f c 31�S� Yc�i 1�G� L''� 2 PhonelEmail 2�6. z29 r2 y7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> (�M/l�� 'C�f phoneJE�mail <br /> BUI DING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> F�cisling Use of Building HFAT SOURCE: <br /> Proposed Usa of Building Gas_ Electric_ other_ <br /> Buildingtype: _SingleFamily _Duplex��wnhouse _Multi-Family �Commercial <br /> Type of project: _New ,�Addition _Remodel _Repair_T.I._Sfgn_Sprinkler_Demolilion_Change of Use <br /> DeSCriplfon of Wofk(addiNonal space proWded on fhe back): , <br /> 1�� �P��,'." <br /> Have you started working without a permlt? ,_YES ./'NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _New_Addn _Alterallon_Repalr TypeofProject: _New_Addn _Altoration_Repalr <br /> Show Number(p)olOxfures Show Numberlpl a���ures <br /> � AIC-air handling units Toilet <br /> Forcedairs slems � BathWb <br /> Gas pipin Lavato (wash basin) <br /> � Waler heater Shower <br /> Gas fireplace Kilchen sink&disposal <br /> Gas ran e Dishwasher <br /> Clothes d er Clolhes washer <br /> Ran e hood Water heater <br /> F�chausl fan Sink(servicelbar/mo letc.) <br /> Heat pump Backflow preventer <br /> Unit healer Urinal <br /> Boiler Drinkin Fountain <br /> Refri eralion Floor drain <br /> Woodstove Grease lre <br /> � Ductin Roof dreins <br /> Olher Medicai Gas <br /> SPRINKLER I PPRESSION SYSTEM Other: <br /> Number of Heads � � Other: <br /> I hereby ceAify lhal I hava read and examined thls applicalion and know tha same lo be Irue and correcl.All provisions ol laws and ordinances goveming <br /> this type of vrork will be complied wilh whelher specified herein or not.The grenting ol a permil does not presume to give authonty lo violate or wncel <br /> the provision of any other stale or local law reBulaling construclion or Ihe pertormance of constNctlon.That I am authorized by lhe owner ol this p�operty <br /> lo pedorm the work for which appli ation is made and I compty with tha Stala Conl2ctors Law 10.27 RCW and 298.200 WAC <br /> ,,. 3 . �_ 2 <br /> � rRewsed vzo�,� <br /> OwnMlAulhod¢�e Agent SI aturu Dale '/ <br /> � <br />