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PERMIT APPLI�ATIOfV <br /> BUILDINGIMECHANlCAL/PLUMBINGISIGN/SPRINKLER/DEMOLITiGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everetf, WA 98201 -425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S � �— �I <br /> SITEADDRESS: �ROVERTv7A%p PE IT�Y <br /> /5 ob' ,-P ' O S -OO <br /> LEGl�L lor new conslruction: hah PlaVsu�divisian Lol No._ (altach copy of lona legal description) <br /> OVJNER ��p/l��/� � Phone/E�mail �KJCi ` U/-�o � a <br /> Address ���j� �� "�,"Q Ciry/State/ZiP .�(/ � �'1 ' � C� <br /> �ONTRACTOR S L&I Lic.# S 1'�q � <br /> Address �,33'-.:���GCL'V'���� � /qlr / 3 Phone/Email � �� —� ���5� <br /> TENANT bU51NES5 NAME CONTACT FQ PERMIT <br /> � .tt�i / � <br /> Phonc/E-mail �tp0 3S ��3-'� <br /> BI,�iLDING PERMIT APPLICATiON CONiRACT PRICE oF WORK 3('�C1C�J <br /> Existing Use of Building HEAT SOURCE: <br /> Propased Use of Building Gas__ Electric_ other_ <br /> Ouilding lype: _Singie Family _Duplex_Townhouse _Mulii-Family _Commercial <br /> Type of oroject: _New _Addilion __Remcdel _Repoir_T.I._Sign_Sprinkler__Demolition_Change of Use <br /> Desc�iption of Wodc(addrtional spacaprovided on Iho bock): <br /> Have you started working without a permit7 _YES _NO <br /> MECHANICAL PERMlT APPLICATION PLUMBING PERMIT API'LICATION <br /> Typo of Profoct: _New_Addn ,�Alleratlon_Ropair Typo ol ProJect: _Now_Addn _Alle•atlon_Ropalr <br /> Shaw Number(H)aI lixtures Show Number/p)oI/ixfures <br /> NC—airhandlingunits I Toilet <br /> � Forcetl air syslems Bathtub <br /> � Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas frcplace Kitchen sink 8 di,posal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood I Water heater <br /> Exhaust fan Sink(service/bar/mopletc.) <br /> I Heal pump �ackllow preventer <br /> Uni�heater Urinal <br /> IBoiler � Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove � Grease trap <br /> Ducting I Roof drains <br /> � Other i Medical Gas <br /> 's�'PRINKLER I SUPPRESSION SYSTEM I Other <br /> � Number of Heads I Olher. <br /> I hereby ceAity that I have read and examined lhis applicatmn and know Ihe same lo ba tme and wnect.All provisions af laws and ertlinances governing <br /> this lype ol r+ork will be complied wilh whelher specifed herein or not.lhe granting ol a pertnil Coes not presume lo giva aulhcnty lo violato or cancel <br /> the pmvision ol any other state or local law regulaling constmction or the pedormance o(conslruc!ion.Thal I am authoCzed by Ihe m•�ner ol lhis pmpetly <br /> to perlorm e wurk for which a hcation is mada and I comply w�ih Ihe State Contraciors Law 78.27 RCW and 296200 WAC <br /> � � ���/ <br /> � LO"�C� �1 <br /> �wnodAutho aA Agont Slgnaturo Date (Revisetl2/�Of 1J <br />