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r <br /> PERMIT APP(_ICATION <br /> BUILDING/MECHANICAL/P!UMBIhIGISIGN/SPRINKLER/DEMALITION <br /> CITY OF EVERETT PERMIT SERV!CES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM '- �' <br /> SITE ADDRESS: PROPERTYTAX PERM <br /> C ' / i r OS 00 02 / - C7 <br /> LEGAL for new conslruclion: Shod PlaVsubdivision Lot No._ (altach copy of long legal description) <br /> OWNER /� PhonelE-maii J6 �S � � / <br /> Address , ,�{ S „( �� �/ � / City/Stale/Zip s�j/(��jf�% �S(� (�/j� �O �r� <br /> CONTRACTOR /��S� C L&I Lic.# .Sn .� rO � ) <br /> Address ,j� /� � Phone/Email p,6 � /S O / <br /> TEiJAYT BUSINESFi AME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLI�ATION coN7HACT aRICE oF WORK <br /> Exisling Use of Builtling HEAT SOURCE: <br /> PfopOsed Use of Building Gas_ Electric_ Olher_ <br /> Building type: _Single Family _Duplex_Townhouse _Mulli-Fami!y _Commerciai <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Changa of Use <br /> Description of Wo�lc(additional space provided on the back): <br /> Have yo�staRed working wiN�out a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _Now_Addn _Altoration_Ropalr Typn of Pro�oct: ,_ Now_Addn _Allnration_Ropalr <br /> Show Number(M)o!fixtures Show Number(p)oI�xturcs <br /> A/C-air handling unils Toilel <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Waler heater Shower <br /> Gas fireplace Kitchen sink 8 dispcsal <br /> Gas range Cishwasher <br />� Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaustfan � Sink(servicelbar/mop/etc.) <br /> Neat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstoae Grease trep <br /> Ducling Roo(drains <br /> Olher Medical Gas '�. <br /> SARINKLFR / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> i hereby certify ihat I have read and examined ihis applicatlon and kuu,v the same to be Irue and conect.All provisions of laws and ordinances goveming <br /> Ihis lype of work will be complied with whelher specified herein or noL The granting of a permit does not presume lo give authorily to vlolate or cancel <br /> the pmvi,ion of any other slale or local law regulaling consiruclion or the pertormance of constrvction.That I am aulhonzed by ihe o�mer of lhis pmperty <br /> to pedortn the work for wl}Ich application is m�and I comply with the Slzle Conlractors Law 18.27 RCW and 29E.200 N'AC <br /> � �• , '.C�� d�—/-/� <br /> wnorl ut orzoAAgentSlgnaWro J Date (.4evised22011J <br />