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PERMIT APPLICATION ;; -a-8-) � <br /> BUILDING/MECHANICAL/PLUMBING/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 /> qPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX p ERMIT i <br /> ' � _�/y/ S� �� <br /> LEGAL lor new conslruclion: Short PlaVsubdivision Lot No._ (al�ech copy of long legal tlescnplion) <br /> OWNER Phone/E-mail <br /> Address City/51a�e/Zip <br /> CONTRACTOR /�k Br Lu L&1 Lic.# <br /> naa�ess I/F5a3 fle5i��n�s ,��e,wn�sl r Phone/Emall `f�•E-Q3�` 32/9 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ��� ��n5 /f"j��5 Phone/E�mail 2�6-3�6 -�vn� <br /> BUILDING PEf�MIT APPLICATION CONTRACT PRICE OF WORK 9, 970• 3 E <br /> Exisling Use o(Building HEAT SOURCE: <br /> pmposed Use of Building Gas_ Electric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_�emolition_Change of Use <br /> Description o(Work(edditional spaceprovidedon fhe backJ: <br /> Have you started working wilhout a pertnit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofProJacl: _Now_Addn _Altoratlon_Ropair TypoolProJoct: _Naw_Addn _Alteration_Ropalr <br /> Show Numbcr(M)ol lixtures Show Numbcr(M)of Rxfures <br /> A/C—air handling unils Toilet <br /> Forced air syslems Bathlub <br /> Gas piping Lavato (wash basin) <br /> Waler heater Shower <br /> Gas freplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clolhes d er Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etcJ <br /> Heat pump I Backtlow preventer <br /> Unil heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeralion Floor drain <br /> ' Grease trap <br /> Woodslove <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other. �e �� �i. � - r- -��r� <br /> Number oF Heads Other: <br /> I hereby certily Ihat I have read and examined Ihis application and know lhe same lo bo Irue and correcl.All provisions of laws and ordinances gaveming <br /> ihis type ol work will Ue complied with whMher specifed hercin or nol.Tha granting ol a permit does not presume lo give authonty lo vlolalo or cancel <br /> Iho provision of nny other s1ale or local law tegulaling consWclion or Iho pertormance ol consiruction.Thal I am authonzed 6y Ihe o�mer of this propeAy <br /> to pertorm tho work for�vhich opplicalion is mado and I comply with Iho Stala Conlractors Law 10.27 RCW and 296200 WAC <br /> ;'/l� r�-�__ 3-2$-i/ <br /> OwnorlAuthorizod Agont Sipnaturo Data (Revised 22G71) <br />