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( � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT 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 '�I 6�� <br /> SITE ADDRES PROPERN TA%A P�RIAIT# <br /> (� �D � � —C�il� <br /> LEGAL lor new constructlon: Shcrt lallsubdivision Lot No._ (allach capy ol iong legal desuiptlon) <br /> OWNER � C�L" S/ % � E (l PhonrJE�mail <br /> / / /� � / <br /> Address Z Y l /�—i l(`?��' �/� CitY/51atGZip f'�c^�' � (i`�f� Z(j��� <br /> CONTRACTOR iCrs �✓^l�� /i�" �^" L&I Lic.# <br /> Address p j L(� �Zv�'i"� ��lyL�"F Phone/Email <br /> TENA T BUSINE55 NAME CONTACT POR PERMIT <br /> P�one/E-mail <br /> BUILDING PERMIT APPLICATION cON7ancT PRICE OF WORK <br /> Existing Use of Building_ HEAT SOURCE: <br />� Proposed Usa of Building Gas._ Electric_ Other_ <br /> Building lype: _Single Family _Duplez_Townhouse _Multi-Family _Commercial <br /> Typeofproject: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change ofUse <br /> Des[ripllon of Wofk(addifional space provided on fhe backJ: <br /> Havoyoustartedworkln�wilhoutaperinit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoalProJect: _New_Addn _Alteratlon_Repair TypoofProJect: _New_Addn _Alterallon_Repalr <br /> Show Num6er(N)o/1Lrfuics Shmv Num6er(71)al flx(ares <br /> A/C–air handling unils Toilel <br /> � Forced air systems � Balh�ub <br /> � Gas piping Lavato wash basin) <br /> Water heater Shower <br /> � Gas freplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes d er � Clolhes washer <br /> Ran e hood I Waler heater <br /> Exhaust fan I Sink service/barlmo /etc.) <br /> Neat pump � Backflow preventer <br /> Unil healer � Urinal <br /> Ooiler Drinkin Founlain <br /> Refrigera�ion Floor drain <br /> Woodstove Grease lra <br /> �ucting Raof drain5 <br /> Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number of lieads Other: <br /> I hemby cetlity Ihat I have read and esamined lhis applicatlon and knmv iho samu lo Ee truo xnd correcl.All provlslons ol laws antl ortlinances goveming <br /> Ihis typa of work�sill be compiied wlh whether specifed hemin or not.The granting ol a permA tlots not presumo�o glve authority to viola'a or wnc=1 <br /> Iha provislon ol any olher stale or local law regulating wnsimclion or tho pertormanco of censWclion.That I am authodzetl by IAe owner ol thls propetly <br /> to pertorm t�yre6�k for wh�ch a plication Is made and I wmp vnth!he State Contrac!ors law 18.27 RC W and 288.200 WAG <br /> 7 ��� <br /> i l�` ��G�% �/ �-�i 7�'i/L <br /> Ow erlAulhodzed Agent Signatum � Oalo (Revised7/PO11J <br />