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� ( <br /> PFRMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBIN�/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT FERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857—www.everettwa.org / <br /> APPLICATIONS.4RE ACCEPTED FROM 8 AM TO 4 PM � � �`/ <br /> SITEOA�RESS: O � A ���0� PROPERTYTA%H PE IT / � <br /> LEGAL fot new construclion: Shorl PlaVsu6division Lot No._ (at�ach capy of long Iegal description) <br /> OWNER � � Zo�C� SS, Phone/E-mail �Z�-7 �d 1_I� �Q�Q, Qn�^ <br /> Address �p� City/Stale2ip uQ,�Q PC "1 pzJ <br /> \ � <br /> CONTRACTOR�` �SC� C n L 8 I Lic.# LS M'� 1 <br /> Address 3 �2 �1Z,r�� �_ �.ti. Sncitia�:�s\ .,P q�z��L Phone�emai� �j�-533'Cb$S V�lacx�. 24r � «�� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Lo� <br /> �\U � �,��� PhonelE-mail 2.ob-5�-ob�5 �h(x �� <br /> BUILDINGPERMITAPPLICATION coNTRACTPRICEOFWORK <br /> Exist�ng Use ut Building ��• �"��+'���'a HEAT SOURCE: <br /> Proposed Use of Buiiding _ Gas_ Eleclric_ Oiher_ <br /> Building type: _Single Family _Duplex_Townhouse �Multi-Family _Commercial <br /> Type o(project: _New _Addition �[Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Descrip�ion of Work(additional space provided on the beck): <br /> Have you sWrted working without a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATIQN PLUMBING PERMIT APPLICATION <br /> TypeotProJect: _Now_Addn _Altoration,�Ropalr TypeofProJect: _New_Addn _Alleration_Repair <br /> Show Number(p)ol/ixtures Show Number(#)a1 Rxfures <br /> A/C—air handling units Toilet <br /> Forced air syslems Bathtub <br /> Gas piping Lavalory(wash basin) <br /> Water heater Shower <br /> Gas freplace Kitchen sink&disposal <br /> Gas range Dishwasher <br />.'� Clothes dryer Clothes v.�asher <br /> Range hood Water heater <br /> Exhaust fan � Sink(service/badmop/etc.) <br /> Heat pump Backflow preventer <br /> Unil heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> O'her Medical Gas <br /> SPRINKLER/ :iUPPRESSION SYSTEM Other: <br /> NumUer of Heads Olher: <br /> I herehy cetlify that I have read and examined thiS.oplicalion and know the same lo be We and conecl.All provisions of laws and ordinances goveming <br /> Ihis lypa of work will be complie�7 wilh v+hether speci�i.d herein or nol.The granling of a permit does not presume lo give authorily ta violale or cancel <br /> ihe pravision of any other state x local law regul.Gng conslruclion or Ihe pedormance of conslmction.Thal I am authorized by ihe ovmer of this pmpeAy <br /> to peAo the wak for vihic GP�ical'on is maJe an�I comply wilh the S�ale Contractors Law iB27 RCW and 296.200 WAC <br /> � <br /> �(.,_ b�- 10-zd1\ <br /> OwnerlAuthorizad Agent Slgnaturo Dale (RevisedY1011) <br />