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( � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGM/SPRINKLER/DEMOLITION <br /> �, CITY OF EVERETT PERMIT SERVIGES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8657 www.e�-e7reriwa.or/q <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM / `�a 6�1 <br /> SITEADDRESS' � PROPERiYTAI(M PERM111Tft <br /> _U <br /> LEGAL lor new consUuc6on: Short PlaVsubdivision Lot No._ (attac`.mpy of lag legal Jescnptlon) <br /> OWNER /)S'/-�G T Phone/E-mail L��S � <br /> IWdress <br /> 7�5 �� S% Ciry�S�ate/uu E(/�' q'g'.�Q <br /> APPUCANT: Owner _OwnersAgent �Contraclor _Conl2ctoYsAgent _TenanlV,.�xpw.w+t,�+w=---"'=T"""-^""°°°^°1�`^V1B�� <br /> CONTRACTOR EC(� '� .S�MS L&I Lic.# 7C.K�S I�- COE Bus.Lic. <br /> S�nS �JI'��- � � PhonelEmail .� QO��C.b <br /> Address �- � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-maii .(]�/� 3C"U6`�GC 2� <br /> � <br /> BUILDING PERiVI1T APPLICASION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas� Elearic_ Omer_ <br /> Buildingtype: �SingleFamily _Duplex_Towni�ouse _Mulli-Family _Commercial <br /> T e of ro'ect: New Addition Remodel Repair T.I. Si n Sprinkler Demolition Chan e of Use <br /> � DESCRIPTIONOFWORK�additrona�spa. �pmvidedonfhebackJ: <br /> ��p lc:c� C.-1 c�� �r,-,��4 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot Projecl: _New_Addn _Alteration�Repair Type of Project: _New_hAdn _Alteration_Repair <br /> Show Number(#)o!fixfures Show Number iW)ol�rtures <br /> AIC-air handlir. units I Toilet <br /> � Forced air s slems I Bathtub <br /> � Gas piping I Lavato �(wash basin) <br /> I Waterheater � _� Shower <br /> � Gas fire lace I Kitchen sink&disposal <br /> � Gas ran e Dishvrasher <br /> Cbthas d er I Cbthes washer <br /> � Ran e hood I Water heater <br /> � � Eshaust fan Sink(service�bar/mopletc. <br /> � Heal um 1 BackFlow reventer <br /> � Unil heater � Urinal <br /> � Boiler I Dnnkin Fountain <br /> � Retri eralion Floor drain <br /> � Woodstove I Grease tra <br /> � Ductin Rwf drains <br /> � Other Mediral Gas <br /> SPRINKLER / SUPPRESSION SYS7EM Other. <br /> � NumberofHeads Other: <br /> � I hem�y ceniy thal 1 have reaE ana exmm�etl Inis apDbm�bn and know t�e same lo 00 lrue antl coned.AlI p�ovlsions oI laws antl oNinanws govemmg ihis ype oI work wil0e complietl <br /> vnlh whe�her spe�etl herein or nol.The granting al n permil Aoas nol presume to give aW�onty to vblate or cancel the pmvision ol any ot�er slale or bcal Ww regulating constmction <br /> 71ia1 I am I�onletl e ownaral t�' mpert o{retlorrn tl�e work IorwOirli appficalion is made an01 comply wA�No Stale Conbatlurs Law 7827 RCW entl Y98 70UA WAC. <br /> / ` ' � <br /> � <br /> O r A lhonzed Agent Signemre Date (Revised fi�2072) <br />