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( �. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.eve/rettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (� - � ��Z <br /> SITE A DRES3: PROPERTV TAX N PERMIT i J h <br /> � �� <br /> IEGAL for new wnsl ctlon: ShoA PleVsubdivislon Lot No._ (attech wpy ol lorp lepal descriptlon) <br /> OWNE -�r <br /> PhonelE•meil � CJ � �� <br /> Address <br /> ,` "� CirylStetelZlp <br /> APPLICANT: Owner OwnefsAgent Contractor Contrador'sAgent _Tenentlmm�pmmeeeienxqmn.emnomn»owanoao.�on�mm.�v�1 <br /> CONTRACTOR U L&I Lic.# COE Bus.Lic.# <br /> Address PhonelEmeil <br /> TE A T BU INE N ME CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exisling Use of Building HEAT SOURCE: <br /> Praposed Use of Building �as Eiearic Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> T ot ro'ecl: New Addition Remodel Re air T.I. Si n 5 rinkler Demolition Chan e ot Use <br /> DESCRIPTION OF WORK(additional space pmvided on the beck): <br /> MECHANICAL PERMl7 APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProJacl: _New_Addn _Altaralion_Repalr Type of ProJ�et: _Nsw_Addn _AlNntlon_Rapdr <br /> Show Num6er(M)olllxturos Show NumWr(N)of flxtuns <br /> AIC-airhandlin units Toilet <br /> Forced air s stems Bethtub <br /> Gas i in Lavalo v+ash besin) <br /> Water heater Shower <br /> Gas fre lace Kitchen sink 8 dis asal <br /> Gasran e Dishwasher <br /> Clolhes d er Ctothes washer <br /> Ran e hood Weter heater <br /> Exhausl fan Sink�senicelbarlmo /etc. <br /> Heat um Backflow reventer <br /> Unit healer _ Urinel <br /> Boiter Drinkin Fountain <br /> Refri eration Floordrein <br /> Woodstove Grease ira <br /> Ductin I Roof drains <br /> Other Medical Ges <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> Number of Heads Other. <br /> I hereby xrtity thal l hem read end exemined this eppGcetion and know Ihe ume to be Ime�m I cortM.Atl provhho�M lawi��d ordinenat povemhg thia rype M��a�Gb� <br /> wilh whel�er speclfleC Aercln or nol.7Te qrsntin9 of e permil Ooes not presume to qlw�ulhorXy to vbiete a canal Ne provbbn o/any dl�er at�ta a bu�4w 2W��9 <br /> 7Tel I am aW�orizatl Cy iha ovmer M t��s ProDeM�o perlorm ihe xrork fa x1JM appikelbn If mWe end I compy wM�IM Slats Contr�don Lr�'1l.27 P,CW nd 288.200A WAC. <br /> �('o , _ � s,�.t,�.- b ��o � la <br /> Ov�erlAuthorizedAgen Slgn uro Dala (Revised62012) <br />