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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/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 <br /> SITEADDRESS: PROPERTYTA%p P RMITp <br /> 7 Ll`i � f'" l(.) �� � ZA <br /> LEGALfornewconstruclion: ShorIPlaVsubtlrvision _______________ ___ ---�otNo._____ (attachcopyoflonglegaldescnption) <br /> OWNER 1� � � '� (v � Phone/E-mail <br /> Atldress � ) � ��U�. ,fi -)1 �-�� w�� CitylSlale/Zip � `U�-c/rT NJ�T `SL-f� <br /> CONTRACTOR�,J � r� ;v ��'.� � ! � L 81 Lic.# I�Q �� l. Y� _ 7 �� �j <br /> Adtlress 1 � ��',�\ � � Q 1 � J ' ��,le:p f�- ��,�Zl.�� Phone/Email zS ��� r� � �S� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT�C�Cu S�L��+J <br /> �^1I I � '�yI /7 ' -1�, �.+�c�� <br /> I`Jl�.L �� ����l`f��I/-' I ll �71�� L-(4 Phone/E-mail �. � j.� 1 � �,1.' 6 3 � -- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ����—____ -- <br /> Exisling Use of Building____ ______ HEAT SOURCE� <br /> ------------------- <br /> Proposed Use of Building___ _______—_ Gas___ Eiectnc____ Other___ <br /> Building type: _Single Family _Duplez_Townhouse _Multi•Family __Commercial <br /> Type o(pmjecl: _New __Addition ___ Remodel __Repair_T.1.�Sign_Sprinkler__Demolition_Change of Use <br /> Descrip�ion of Work(additional spaca provided on fhe back�: <br /> (�vS''FG��:I � � A�k-��� N�l'�1L�7" 6'Jll.�� .������ <br /> � <br /> Have you started working wilhout a permit7 __YES �_NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoolProjecC New __Addn _._Altcratlon_ _.Repair TypeolProJeck ___Nuw___Addn ___Altaration___Ropalr <br /> Show Numba(NJ o/fixtures Show Numbcr(#)olllrfures <br /> AIC-airhandlin units I Toilet <br /> � Forced air s slems I Bathtub <br /> i Gas pipin ' Lavalo (wash basin) <br /> � Water heater Shower <br /> � Gas fireplace ' Kitchen sink 8 disposal <br /> � Gasran e I Dishwasher <br /> �� Clolhes d er ', Clothes washer <br /> �� Ran e hood I Water heater <br /> Exhaust fan I Sink(servicelbar/moplelc.) <br /> Heat pump ( Backflow preven�er <br /> � Uni�heater ! Urinal <br /> '� Boiler Drinkin Fountain <br /> � Refri eration �� Floordrain <br /> Woodstove Grease Ira <br /> ' Duclin ' Rool drains <br /> Other______ _____ ___ i Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Othec <br /> Number of Heads I Olher: <br /> I here�y certity ihat I have read and examined Ihis apPLcation and know Ihe same to be irue and wrrxt.All provisions ol laws and ordinances 9oveming <br /> tnis type ol work wSll be wmplied wil�whelher specified herein ar not.The granting o1 a permlt dces nol presume to give authonty lo violate or cancel <br /> tne provision ot any olher state or bcal law regulaling conslructbn or tha peAormance of construclion.That I am authonzed by Ihe owner ol lhis properly I <br /> w pedorin the wnrk lor ieh application is matle an0 I comply with the State Contracbrs Law 1827 RCW and 296.2U0 WAC � ,� <br /> � '�1�.1�� q � ��I � � <br /> O�Jnerl ulhorized Agent 519naWw Dale (Revised 212011) <br />