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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES g �a1c.�— a-OlZ <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRE PROPERTYTA%p P ITf! <br /> � <br /> LEGAL lor new wnstruclion: Short PlaVeubdivision Lot No._ (attach copy of long legal descnptian) <br /> OWNER L . L�� O. Phane/E-mall� � ��$/ 57 <br /> Address ry Cily/SWtelZip <br /> APPLICANT: Owner _OwnefsAgenl Contraclor _Contraclor'sAgent _Tenanl(m�,�cm�aaomr,eroimnsamo-anmoo.ne��,dowon�nmespace� <br /> CONTRACTOR 1N C� L 8 I Lic. # COE Bus Lic. # <br /> �dtlress PhonclEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-,nail <br /> BUILDING PERMIT APP4ICATION CONTRACT PRICE OF WORK <br /> 2xisting Use of Building HEP.T SOURCE: <br /> Proposed Use of�uilding Gas_.__ [lecinc_ Ot�er __ <br /> Building type: ,�Q Single Family _Duplez_Townhouse _Multi-Family _Commercial <br /> Type o(projecl: New Addition Remodel _Rep�ir T.I._Sign_Sprinkler Demolilion_Change of Use <br /> DESCRI PTION OF W ORK(add�tiona�space prov�ded on the back): <br /> Uerno 5�� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Pro)oct: _Naw_Addn _Alterallon_Repalr Typo ol Projocl: _New_Addn _Alteralton_Ropalr <br /> Show NumDer(q)ol fix(ures Show Num6er(NJ ollirtures <br /> AIC—air handlin units Toilcl <br /> forced au systems ; �alhtub <br /> � Gas pipinq I Lavatory (wash basin) <br /> Water healer Shower <br /> Gas f�ep!ace � Kitchen sink 8 disposal <br /> Gas rangc I Dishwashcr <br /> Clothes dryer Ciolhes washer <br /> Range hood Wa1er heater <br /> Ezhausl lan Sink(servicelbarhnop/elc.) <br /> Hcat pump Dackflow preventer <br /> Uml hcatcr Unnal <br /> �ailer Urinkin�Founlain <br /> � Kc(ngcration � Floor drain <br /> Woodstove Grcasc Irap <br /> �ucliny Rool drains <br /> Olher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM ! other. <br /> Numbcr of lieads � Other <br /> I hcicby xNly thnl I havu rcaJ and caamined Ihrs appfcn:inn and knov;Ihc;amo tu Uc huc and concct NI provisrons ol lar�,and a�diwnccs govcrnin9 t�i,lypc cf work x�A 6c compl�.cA <br /> w:th wficihcr s�r.rAicd�cicin or not.Thc�mnling of a pcimA doc5 not D�esuma ta qNc aulhordy to viota;c or�inul Ihc provision al any olhn stalc or local Imv regula9nq wnsWclion <br /> Tnal I am;mmorbrJ�y thc rnmcr ol lhls pioperry�o pcnorm Inc woik applic ' n is�wdo antl I mmply w�th Ihc Statc Coniraqors 1 aw IB J7 RCW and 294]OOA WAC. <br /> � �lv <br /> � /o-.���� <br /> O norl th riccdA I tSignaWro� ate ' (Rev�sedC✓10121 <br />