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PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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 4 PM C7 � �� �� <br /> SITEADDRESS: On ��/P� �_ PROPERTYTAXp �RMITt �� `Or _� <br /> �J <br /> LEGAL for new conslrucllon: ihort PlaVsubdivision Lol No._ (allach copy of long legal descrip�ion) <br /> OWNER -(i — �(�f >� Phone/E�mail '7°�.S' 3 �9- ��� �� <br /> Atld�ess �/70�j �.JCeJ? Qc�, CitylSta�e/Zip C � W/} �J8ao3 <br /> CONTRACTOR L� �e P Y.�/�C� L&ILic.# Soule�n +�9.(S�T �o�-ys� 9ia <br /> Address a�s �'c' � /�I�I�I (.U-� vl��! PhonelEmeil p<<-� "�(� '�/ 0� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT / <br /> PhonelE-mail " J��' v��� a�� J91o' ��`��� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � �• "' <br /> Existing Use ol Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <br /> Building type: _Single family _Duplex_To�,vnhouse _Multi•Family _Commercial I <br /> Type o(projecl: _New _Addilion _Remodei _Repair_T.I._Sign_Sprinkler_Demclition_Change of Use ��� <br /> Description of Wo�1c(edditional space provided on fhe bnck): <br /> Have you started working without a permit7 _YES �O <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofProJoct: _New_Addn �Altaratlon_Ropair TypeofProJeU: _New_Addn _Altantion_Repalr <br /> Show Number(N)o//ixturos Show Number(M)o/flxturea <br /> A/C—air handling units Toilet <br /> Forced air systems 6alhtub <br /> Gas pipin Lavato (wash basin) <br /> Water heater Shower <br /> Gas firepiace Kitchen sink 8 disposal <br /> Gasrange Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump BackOow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refrigera�ion Floor drain <br /> Woodstove � Grease trap <br /> Ductin Roof dreins <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> I hereby certify that 1 havo reatl and e:amined Ihi;applicalion and know Iho same to 6e Irue and correct.All pravisions ol laws and ordinances goveming <br /> Ihis type ol work will be complied wilh whelher specifed herein or noL Tho granting of a permit does not presume to give aulhonty to violate or cancel <br /> Ihe provision of other slale or locat law regulating construction oi the peAormance ol conslruction.Thal I am aulhorized by Ihe owner ol l�is propeAy <br /> to perto�i t � vh' h applicaqon' mada and I comply with the Stale Contractors Law 18.27 RCW and 29�200 WAC <br /> /�1�/',�;-„ t ;r� �/r�'/� <br /> wnerlA lhorizod Agont Signaturo Dato (Revised 2/2017) <br />