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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SFRVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: _n/ PROPERlVTA%!7 PERMIT# _ � <br /> q�(! <br /> LEGAL for new construction: Shart PlaUsubdivision Lol No._ (attach wpy ot long legal descriptlon) <br /> OWNER L q i PhonelE�mail Z - � � • 4v Z-� <br /> Address SU/ <br /> Ciry/Statelzip �✓�l D/ <br /> CONTRACTOR L&I Lic.# <br /> Address � ✓ PhonGEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONiRnci PRICE oF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Duilding�P n� Gas� Electnc_ Other_ <br /> Building type: _Single Family ,_.�Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: �ew _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> Descriplion of Work(addifional space provided on fhe backJ: <br /> f"�/ew �G..S �i n��� � <br /> Have you started working without a permit? _YES _NO <br /> MEl':HANICAL PERMIT APPLICATIOPi PLUMBING PERMIT APPLICATIflN <br /> TypeofProJecl: _New_Addn _Alteratlon_Repalr TypeofProJecl: _New_Addn _Alleratian_Repalr <br /> Show Num6er(�)ol flxtures Show Number(N)ol llxfures <br /> A/C-airhandlingunils � Toilel <br /> � Forcedairsystems I Bathlub <br /> � Gas piping � Lavato (wash basin) <br /> � Water healer � Shower <br /> � Gas fireplace Kitchen sink&dis osal <br /> Gas range Dishwasher <br /> � Clothes dryer � Cbthes washer <br />�"��'` � Waterheater <br /> Range hood <br /> Exhausl fan ( Sink(service/bar/mop/etc.) <br /> Heat pump I BackBow preventer <br /> Unit healer � Urinal <br /> Boiler Drinkin Fountain <br /> Refri eralion Floordrain <br /> Woodslove Grease trap <br /> � Ducling Roof drains <br /> � Olher Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I Other: <br /> � Number of Heads I Other: <br /> I hereby certity Ihat I have read and ezamined ihis appliwtion and know tho same lo be true and wrrect.All p�ovisions ol laws and orEinances goveming <br /> this lype ol work will he complietl with whether speci�ed herein or noL The granting ol a permit does not presume lo give aulhority lo violate or wncel <br /> the provision of any other state or local law regulating wnsWction or Ihe pertortnance ol consWction.That I am authorized by Ne owner ol t�is properry <br /> to peAorm th vrofl�tor which application is made and 1 compry�.vith tha State CoNrectors Law 78.27 RCW and 296.200 WAC <br /> � ,L,� ��� '?� /� `� 2_ <br /> wnerlAuthodzed Agent Signature Date (Revised 7/2017) <br />