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( <br /> PERMIT APPLICATION <br /> BUILDIN�/MECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES S" (9 " I I <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa. � _ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE�DDF�RES U �� Wn n�ZJ� PROPER7YTA%H PERMI <br /> � t'I' 7 <br /> LEGAL lor new construction: ShoA PlaVsubdivisian lot No._ (al�ach copy ol long legal description) <br /> � 1 n ` <br /> OWNER�v�'[�' PhonelE-mail -tpk, c(� — y <br /> Address i � o �,9, C f- �J'T Ci�ylSlate/Zip <br /> CONTRACTOR L&i Lic.# <br /> Address PhonelEmall <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERM'IT APPLICATION CON7RACT PRICe oF woRK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Builaing�24U4 ia _ Gas_ Electric_ other,_. <br /> 8uilding type:�Single Family _Duplex_Townhouse _Multi•Family _Commercial <br /> Type of project: �New _Addition _RemoCel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(addifional space provided on fhe back/: <br /> Have you staAed working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBIh1G PERMIT APPLICATION <br /> Typoo(ProJoct: _Nnw_Addn _Altoration_Repalr TypoofProJact: _Naw_Addn _Alteralion_Repair <br /> Show NumbcrJH)o(Iixturns Show Numbor(p)olllxtures <br /> A/C—airhandlingunits \ Toilel <br /> Forced air systems Bathlub <br /> Gas piping Lavalory(wash basin) <br /> � Water healer Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clo�hes dryer Clo�hes washer <br /> Range hood Water healer <br /> Exhaust fan Sink(service/bar/mop/elc.) <br /> Heat pump Backtlow prevenler <br /> Uni�heater Urinal <br /> Boiler Drinking Foun�ain <br /> Refrigeration Floor drain <br /> Woodstove Grease lrap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> INumber of Heads Other: <br /> �hereby certify ihal I have read anA ezamined this applicatlon and know the same lo be trun and conect.All provisions of laws and ordinances goveming <br /> �his type of work will be complied with whelher specifed herein or nol.7ha granting of a pertnil does nol presume to givo aulhority tu violale or ca�cel <br /> ihe provision of any other stale or local law regulating consiruclion or Ihe perlormanco of conslruction.Thal I am authorized by the owner of this propeAy <br /> to erlorm�he work f r which applicalion is made and�comply with tha State Contractors Law 78.27 RCW and 296.200 WAC <br /> �— �� <br /> O lNWi ze A§ontSigneturo Dale (Revised22011) <br />