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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/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 />v .r1.0TCn Cor1M A AM TO A PM / ,--4 <br />APPLi VA i wrw nna-....v-. ..._ ..._... _ ..._ . <br />9 L PROPERTYTA%A <br />(G <br />SITE AS S <br />G P.ICrrQE� <br />VA <br />LEGAL for new construction: Shod Plat/subdivision Lot No._ (attach copy of long legal description) <br />tl &/` PhonelE.mail - ?S, 6av <br />OWNER <br />t8 6 �� p a� <br />CitylStatelZip QO r� <br />Address <br />l <br />CONTRACTOR �% ) ti �t % L 8 I Lic. # <br />- Phone/Email <br />Address <br />TENANT BUSINESS NAME �. <br />CONTAC OR PERMIT <br />P <br />BUILDING PERMIT APPLICATION <br />CONTRACT P cE of WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building GasElectric_ Other_ <br />Building type: Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />_ <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />Description of Work (additional space provided on the back) : <br />-.L 4) (W a"le- C'1 S�Q <br />Have you started working without a permit? _YES —NOr <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: ZNew_Addn _Alteration _Repair <br />Typo of Protect: _New ___,Addn _Alteration _Repair <br />Show Numbor (70 of fixtures <br />Show Number (o) or fixtures <br />A/C — air handling units <br />Toilet 2- <br />Forced air systems <br />Bathtub <br />Lavatory (wash basin) <br />Gas piping <br />Shower 2. <br />.� Water heater <br />I <br />Kitchen sink &disposal <br />I Gas fireplace <br />Dishwasher <br />Gas range <br />I <br />Clothes washer <br />Water healer <br />Clothes dryer <br />Range hood <br />Sink (servicelbarimoplelc I <br />Exhaust fan <br />BackfloW preventer <br />Heal pump <br />I Urinal <br />Unit heater <br />I Drinking Fountain <br />Boiler <br />Floor drain <br />I Refrigeration <br />I Grease trap <br />Woodslove <br />I Roof drains <br />Ducting <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />I Other: <br />Number of Heads <br />I Other: <br />I hereby certify that I have read and examined this application and knew the same to be true and correct. All provisions of laws and ordinances governing <br />this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give ,uthorily to violate or cancel <br />the provision of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform the work for which application is made and I comply with the Slate Contractors Law 16.27 RCW and 296.200 WAC <br />,ZLI ,-� 6— 3 - t (Revised 2/2011) <br />�� <br />Ow rl wt o z5d Agor SI -aturo <br />Date <br />