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( , <br /> F�ERMIT APPLICATIpN <br /> BUILDING/MEGHANICALIPLUMBING/SIGN/SPRINKI..ER/DEMOLITION <br /> CITY OF EVERET7' PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM , 9 _I--�I <br /> SIT ADDRESS: PROPERNTA%k PERMIT# <br /> LEGAL(or new conslruction: Short PlaVsubtlivision Lot No._ (altach copy of long legal descriplion) <br /> OWNE S Phone/E-mail p�S� - � L�O D I �yN <br /> Addressp� CitylStale/Zip � �(/ (� "-o� o� <br /> CONTRACTOR S N S � L&I Lic.# S <br /> Address (�. � I O ( U{� PhonelEmail ' � $� - S �_ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDINCi PERMIT APPLICATIOM CONTRACT PRICE oF woRK <br /> Existing Use of Building�nV1^F' HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other <br /> Building lype: �i Single Family _Duplex_Townhouse _Multi-Family _Comn�sr:ial <br /> Type of project: ,_New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> Descriplion of Work(addifional;pace provided on fho 6ack): <br /> �� ��� r <br /> Have you started working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of ProJact: _New_Addn _Alturation_Rapair Typo of ProJoct: _Now_Addn _Alteratlon_Repalt <br /> Show Number(#)o//ixtures Show Number(#)o!(lxtures <br /> A/C-air handling units Toilet <br /> � Forced air syslems Bathtub <br /> Gas piping Lavalory(wash basin) <br /> VYater heater Shower <br /> Gas freplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clolhes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump BackOow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Re(rigeration F�oor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby ceAify�hat I have read and examined Ihis applicallon and know Ihe same�o be irue and cortect.All prcvisions of laws and ordinances governing <br /> this type of work will 6e complied wilh whether specifed herein or not.The granling of a pertnil does nol presume lo give aulhority lo violale or cancel <br /> the provision o(any other stale or Iacal law regulatin�conslruc�ion or the pedormance of conslruction.That I am aulhonzed by�he owner of ihis pmpedy <br /> to peAortn lhe,work f which applicalion is made and I comply wilh Ihe Slale Conlractors Law 18.27 RCW and 236.200 WAC <br /> n // ,�7 p q� <br /> • �(t� ��t�//iti�.�l /'� '"'iX/�� <br /> OwnerlAirthorized Agont Signature Date (Revised?/2017) <br />