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�ERMIT APPLICATI• <br /> BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERYICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 9 PM <br /> SITE AODRESS:��22 ���0� vROPERTv Tnlf r, D O 0 P - �� <br /> t"OTt � <br /> LEGAL(or new eonsWclan: Short PlaVsubdivisio� Lot Na._ (atlac�wpy o(long lepal desuiption) <br /> OWNER �nq �� Pnone/E-mail 3� q'� <br /> d�ss 22 �esf ���,5�e��,Z�o v�lA q$2o3 <br /> CONTRACTOR I 8 I Lic.# r F OlY CJ <br /> Atldress �I 1�� S'r . �1 MI,T q gU� 3 P�one/Emai ��J � — <br /> TENANT BUSINESS NAME ONTACT FOR PERMIT A m I� G v S�i'�11 <br /> PhonelE-mail n� U� Q� � �l. r 1 •( <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: � <br /> Proposed Use of 6uilding Gas Ebarie Omer <br /> Puilding type: _Single Family _Dupiex_Townhouse _Multi-Famiiy _Commercial <br /> IType of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work�additionai space provideC on the Dack): <br /> Have you s'arted working without a pemiit7 _YES =N0 <br /> M�dCNANICAL PERMIT APPLICATION PLUMBING PERMiT APPLICATION <br /> TypeWProJaet: _New_Addn !Wndon_Rapair TypeofProject: _N�w_Addn _Albratlon_Rapair <br /> Show Number(I)o/firtu�es Show Number(M)oI Muros <br /> A/C-airhandlin units Toilet <br /> � Forced air s stems Y Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shawer <br /> Gas fire lace Kitchen sinlc 8 disposal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Watei heater <br /> Exhausl fan Sink service/bar/mo letc. <br /> Heal um Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eratian Floordrain <br /> Woodstove Grease tre <br /> Ductin Roof dreins <br /> Other Medical Gas <br /> SPRINKLER I 8UP!�''REBSION BYST�M other: <br /> Number of Heatls Other: <br /> I hereDy cehiy lhal I have read aM examinetl Ihis applicalion anU know the same to be lrue antl correct.AN provisions of laws antl ortlinances governing <br /> Ihis type o(work will be complied wilh whethsr specifietl hemin or not.The granting af a peimit tloes nol presume to give aulhonly to violate or cancel <br /> Ihe Orovision ol any ol�er slate or local la++regulaling construdion or Ihe peAormance o(constructian.That I am aulhorizeC Oy the owner of lhis propeAy <br /> to peRorm the wpork for wnhich applicalion is maCe aM I rnmply wilh the State Contredors law 18.27 RCW anA 296.200 WAC <br /> IAA.YYIA.CXX 1 'CUIX�I anr � �V ��—��I <br /> OweadAuthoNzad Apent Signature Date (ReviseJ?/2017) <br />