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PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPL�JMBING/SIGNISPRINKLER/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+PM <br /> SITE ADDRESS: PROPERTY TA%N RMIT t <br /> � ( 3 � Co �n„ � /�u-e_ I o�'o <br /> LEGAL for new construclion: Short PlaVsubdivision Lol No._ (atlach copy of long legal description) <br /> OWNER � PhonelE-meil y "- 6 fl/- SS^ � <br /> naaress Z ' -Co u t CitylStatelZlP � f GJ Z d <br /> CONTRACTOR Q � L 8 I Lic.# L G <br /> Address 1 0 26 � `��'' /�-ue S Z 8 � PhonelEmeil �f2. ^-338-s`f� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �� <br /> � - � _ I� PhonelE-mail �^^3�8 --r-7 �y <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK C� v U • U� <br /> Existing Use of Building HEAT SOURCE: <br /> Propased Use of Building Gas_ Etectric_ Olher <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _A�ldition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> D85Cfiption o(Wofk(edddional spaca provided on the beckJ: <br /> Have you started working without a pertnit7 _YF.S _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJact: _New_Addn �Alteratlon_Repelr Type of Projecl: _New_Addn _Alteration_Repair <br /> ShowM• nber(N)ol/ixfurea ShowNumbx(M)o/Ilxturea <br /> A/C-air handlin units I Toilet <br /> Forced air s stems Bathtub <br /> Gas i ing Lavato wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Range hood Water heater <br /> Exhausl fan Sink(service/barlmop/etc.) <br /> Heal pump Backflow reventer <br /> Unit healer Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floerdrain <br /> Woodslove Grease tra <br /> Ductin Roaf drains <br /> Other Medical Gas <br /> SPRINKLER i SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certily Ihat I hava read and examined this applicalion and know the same to be true and conect.All provisions of laws and ordinances govemin� <br /> lhis typa of�mrk will be complied with whelher specifed herein or nol.The granling ol a pertni�does not presume�o give aulhonty to violale or cancel <br /> the provision ol a�y other stale or local low regulaling conslniction or the performance ol construction.Tnal I am authorized hy Ihe owner ol lhls property <br /> to pedortn 0 work lor which application is matle and I comply with Ihe S�ate Contractors law 18.27 RCW and 296.200 WAC <br /> ..P �� �_ 3 -2� - t � <br /> Owno AuthorzedAgentSignature Dale (RevisedY2011) <br />