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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLERIDEMOLITION <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 /> SITEADORESS: � O � /�✓� PROPERTVTA%M P I�� "O <br /> ��7 <br /> LEGAL lor new construclion: Short PlxVsubdivision Lot No._ (attech wpy ol long Iagal description) <br /> OWNER C PhonelE•mail a -S83 �9a i i <br /> Addross y Q e Q CitylStatelZip �� <br /> APPLICANT:_Ovmer OvmersAgent �Contraclor ContractolsAgent _Tenanll�•.�w�'be.bne�oiw�.em�,meo�e��oaowon�nmew.rol <br /> CONTRACTOR C L 8 I Lic.# 2 � J COE Bus.Lic.d ��'!S <br /> �ddress �a�l � Ve � . l � � 3 Phone/Email � — 7 � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT/� { T �Vf <br /> �� / <br /> Phone/E-mail (p�' .�" � <br /> BUILDING PERMIT APPLICATION coNTRaCT PRlce oF woRK 0 O D . �' <br /> Existing Use of Building /� � HEAT SOURCE: <br /> Praposed Use of Building �n a- � Gas Eiectnc_ Other_ <br /> Building typu: �Singlo Family _Duplex_Townhousa _Mulli-Family _Commercial <br /> T e of ro'ecl: New Addition Remodel Re air T.I. Si n S rinkler Demolition Chan e ot Use <br /> DESCRIPTSON OF WORK(ndditional spaca providod on tho beck): <br /> .�-rn5fa ll�,�ion v{� a �ew �s ��na� °� �s �,Q�a c� . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeotPro�ed: _New,�Addn _Alteratlon_Repalr TypeolProJect: _New_Addn _Alteratlon_Repalr <br /> Show Number(M)otllxturas Show Number(p)01 flxtures <br /> AIC—airhandlin unils Toilet <br /> Forced air s stems 8athtub <br /> Gas pi in Lavato wash basin <br /> Water healer Shower <br /> Gas Ore lace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clolhes washer <br /> Fan e hood Water heater <br /> Exhaust fan Sink service/bar/moplelc.) <br /> Heal um Backflow preventer <br /> Unit heater Urinal <br /> Boiler Dnnkin Fountain <br /> I Ro1ri eralion Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER / Sl1PPRESSION SYSTEM otner: <br /> Number of Heads Other. <br /> I nereby ceMy thet 1�avo read and eaemined this applkaliun end knaw 1�e¢ama to be We anC cortact.A1 pmvislons ol laws and aMnances goveming Nh lypa o�work w+�Ea mmpLetl <br /> wth wfieNor s0ecified heroin ar not 7he Brnnting ol a pormR doee not prasume lo gNe auNonry to vioWie ar wncal Ne pmvision ol eny alhar sWle or bca�law reguWting cansW ction <br /> Thal l em eulhotlzod bytho owncr o/lhis D�7crry to pedorm iho xodc Iorv.Tich npPlicauon is malu end I complywnh Iho 5lelc Cont2ctars lew 18.27 RLW end 296.200A WAC. <br /> /�� /�� �//� (RevisedN2012J <br /> OwnerlAuthorizedAgentSignaturn Dato , <br />