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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGNISPRIN KLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 426-257-8857—www.everetriva.org <br /> ApPLICATIONS ARE ACCEPTED FROM 8 AIA TO 4 PM � � �-I 7/ <br /> SITE ADDRESS:�%� PROPERTYTAX N ERMIT p <br /> LEGAL for new moslruction: Short Plat/subtlivision Lol No._ (attach copy oi IonB legal descnpllon) <br /> OWNER i (' �J�p'� PnonelE-mail y..7� s 7' 3 p <br /> Address � Cj !�� CitylState/Zip ��`. ��'�� <br /> CONTRACTOR ,��ti�:l- �/''� .� �' L&I Lic.# S U C� � � - • y� � <br /> Atltlr=ss (`)I 7�-�/ �SS ' ��' J��� �� L✓� � Phone/Email �G�- �I ^ �7�� <br /> TENANT BUSINESS NAME ONTACT FOR PERMIT <br /> Phone/E-mall �(/U- .5 /� —/ �� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WURK <br /> Exisling Use oi Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ elemnc_ Other_ <br /> Bwlding lype: _Single Family _Duplez_Townhouse _Multi-Family _Commercial <br /> Type of project: _Nev� _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change ol Use <br /> Descriplion of Work(atlditional space provitled on fhe back): � <br /> ���r,����t� G �� l.�%�/�wS+Gr- ���✓G ln,lx�' y �� C�ca� <br /> Hava you started working without a permltT _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7yNaolProJect: _New_Addn _Alteratlon_Repalr TypeolProJect: _New_Addn _Atteration_Repalr <br /> Show Number(p)o!lixfures Show Number(#)alOdures <br /> AIC-air handling units Toilet <br /> Forced air syslems Balhlub <br /> � Gas pipin Lavalo (wash basin) <br /> � Water healer � _Shower <br /> � Gas fireplace Krtchen sink 8 disposal , <br /> Gas ran e Dishwasher _ <br /> � Clolhes d er Clothes washer <br /> Ran e hood � Waler healer <br />� Exhaust fan SinA(servicefbar/mo /etc.) <br /> Heal pump ' BackBow preventer <br /> Uni�healer Urinal <br /> Boiler Drinkin Fountain <br /> Refri eralion Floordrain . <br /> Woodslove Grease tra <br /> � Ductin RooF drains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM I Other: <br /> Number of Heads I Other: <br /> I hereby cerlity lhat I havu read antl examinetl Ihis applicallon antl know t�e szme to be true and correcl.Atl provisions ot laws and ortlinances goveming <br /> this type ai work will be complie0 with whether specified herein or not.The granling ol a permit tices not presume lo give aul�onty lo violate or cancel <br /> Ihe provision of any olher state or local law re9�laling consWciion or t�e pedoimance ot constmction.That I am authorized by t�e owner ol Ihis properly <br /> te pertorm the work tor�Mic�application Is made and I comply with l�e/$�a1e 4%onlrectors Law 1I7.27 RCW and 296.200 WAC <br /> _/ � �/�=�� <br /> Owner/Authodzed A nl Siqnalure Dale (Revised7/1011) <br />