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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everethva.org <br /> � - - ��-I <br /> SITE ADDRESS: ��� .^ � r PROPER7Y TA%p = �oMIT.#_ __ _ _ ,.,� � <br /> v �_ <br /> LEGAL for new conslruclion: Short PlaVsubdrvision Lot No._ (attach copy ol long legat descriptmn) <br /> OWNER 1 �/ S Qr e � PhonelE-maii <br /> Adtlress Cdyl51ale2ip <br /> APPLICANT:_Owrer _O�vner'sAgenl �nlraclor _ContraclofsAgent Tenanl�m�siv��vo�ieneroi�on:c.,itro�omao.nenoeowon�ninosp,ce� <br /> CONTRACTOR� �` S State Lia # City E3us. Lic.1t <br /> Adtlress Phone�Emal <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonM6mail <br /> BUILDING PERMIT APPLICATION CONTRACTPRICE OF WORK <br /> Exrsting Use of 8utldmg HEAT SOURC[: <br /> Proposed Use Of Building Gas__ [lectric Olher <br /> Bwlding lype� _Sng!e Family _Duplex_Townhouse _��lulli-Family _Commercial <br /> Type of pro�ecl. New Addition Remodel Repair_.TJ. _Sign_Sprinkler__Oemoltlion_ Change ol Use <br /> DESCRIPTION OF WORK(add�nona�sn��e p�ov�ded on Ihe backJ <br /> M�CHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _N�w_Addn __Alteralion_Repair Type of Project: _New_Addn _Alteration,_Nepair <br /> SNow Numbcr(pi o/lixNres Show NumGer(N)ol fixtures <br /> A/C—air handling unils I Toilel <br /> I Forced air systems 13athlub <br /> Gas piping Lavatory(wash basin) <br /> Waten c�ater � Shower <br /> Gas freplace � Kitchen sink &disposal <br /> G�s rangc Dish�vasher <br /> I Clothes drycr � Clolhes washer <br /> ; Ranqe hood Water heater � <br /> � Erhaust'an � Sink(servicel6admop/elc.) <br /> � Heat pump Oackflow prevenler <br /> � Unit hr.atcr � Urinal <br /> � �otler Drinking Fountain <br /> Refrigcralion Floor drain <br /> � Woodslove Grease trap � <br /> Dvcting Rool drains <br /> � Olher Medica�Gas <br /> SPRINKtER / SUPPRESSION SYSTEM � Olher: <br /> NumberolHeads � Othec <br /> i nereby ceroly ihal I h;rvo read anU e.ominetl ih�s apPLcaban antl Ynow Ihe sama lo be Ime and conecl A7 prov�smns o1�aws onG ol0inance;govemin9lEiv typo olwork wiil be rnmphed <br /> vnlh w�ciber spcaficC Oc�ein or nal l�c 9raNing ol n pertnit docs nol D�esumo lo givc aWhonty lo notate or wnccl l�c provrsion ot any olnc�slalo or local law regulaling conslrucllon <br /> T�al I am uu�h0�iicrl0y I�c owne�oi lhb p�Operty lo pcAorm I�c�w�k(o�wAie�applKil�on Is matic antl I wmpty w�l�Ihc Slale CoNraclo�s Law IB 77 RCVJanJ P7G 200A N'C. <br /> Owncr/AuOiorized Ac�enl5lgnature Date ptevised9i?OfJ) <br />