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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA�J8[01 425-257-8810 FAX 425-257-8857 www.everettwa.or ^ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � `' I �—� d" <br /> SITEADDRESC� 4 �lM PROPERNTAX# PERM1�T� _ <br /> �lll <br /> LEGAL for new mnstruclio¢ Short PlaVsubdivislon Lot No._ (attach copy ot long Icgal descnption) <br /> OWNER S Phone/E-mail — O ^ (iZ� <br /> Address -{- Ciry/5tate/Z�p � ll� 20 <br /> APPUCANT: Owner _OwnersAgent �Contraetor CO�l�3Cl0i5Ag20� _TC00nl(musipmraeekneralwnsembnmeav.namEowvdinme�pace� <br /> CONTRACTOR S 1n � L&I Lic.# LT COE Bus.Lic.# <br /> Address f+ � Phone/Email �3q7—) O <br /> 'fENANT BUSINESS NAMF � CONTACT FOR PERMIT <br /> Phona/E-mail <br /> BUILDING PERMIT APPLICATION CON7RAC7 PRICE OF WORK <br /> Exisling Use of Builtling HEAT SOURCE: <br /> Proposed Use of Building Gas Etectric_ olner_ <br /> Building type: _Single Family _Duplex_Townhouse _Mulli-Family _Commercial <br /> T pe of pro'ect New _Addition Remodel Repair T.I. Sign_Sprinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK/additiona�space provided on rhe aace): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typoo(Projecl: _New_Addn _Aiteralion_Repalr TypeofPrqect: _New_Addn _P.Iteratlon_Repalr <br /> Show Numbcr(a1 of ltrtures Show Num6er(aJ ol lirfures <br /> A/C-air handling units Toilet <br /> Forced air s stems I Bathtub <br /> Gas piping Lavato pvash basiN <br /> Waler heater Shower <br /> Gas fireplacu Kilchen sink 8 disposai <br /> Gas range Dish�vasher <br /> Clolhes dryer Clolhes washer <br /> Ranne hoou Waler heater <br /> Exhaust fan Sink(service/badmopletc.l <br /> Heal pump � Backflmv preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeralion � Floor drain <br /> Woodstove Grease tra <br /> Ductin Roct drdin., <br /> � Other Medical Gas <br /> SPRINKLER I S��PPRE�SION SYSTEM Othec �,Ja . G�i <br /> � Nuinber of Heads Olher: �! <br /> I hemGy cen�fy thal I hove reaJ and examined l�ls oVPlcnlron and know the same lo Lu lme antl cortecl.A!I provisioro ol lavn aatl oMinnnces goveminp Ihis typo of�wM xiA Ee eompLed <br /> nuh n"mlher speufmd hereln or nol.T I�e gran4.np oi a permd doos nol presume lo gire au;henry lo viGale or cancM iho pmris�en ol any olher st.^.le or local law repulalinp conslrucllon <br /> 1�al I am auNodzeE by Ihe avnet ol lhis pmpci�y lo peitorm lhe v:ork lor w�ich appliw�icn Is m��e a,�tl I comp!y w",h Iho S1.te CoNm.tcn La�,v 1 B27 RCY7 and IP6 2COA VJAC. <br /> L �� <br /> � j�% <br /> -�-��G (Fev,sed 6/2012) <br /> OCincr/ANhorlied Agent Signalurc Date <br />