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� . <br /> PERMIT APPLICATION <br /> � BUILDINGIIIPIECHANICAL/PLUMBING/SIGN/�PRINKLER/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 �a S — � y <br /> SITEADDRESS:� � � � VROPERT/TA7(N P MITN <br /> C _ <br /> < <br /> LEGAL(or new constmction: Short PlaUsubdivision Lot No._ (attach co,.y ot loirg legal descnPtion) <br /> OWNERl��F' / ✓.5�/t� /¢J' T'� Phone/E-mail Z � <br /> Address �C �C � � City/Slate/Zip / . '� � <br /> APPLICANT: Owner Owner'sAgent �Contractor Contrade?sAgent Tenant�m�s�pro.,aea�enerwmnsrnitrommem.re�moov.wa�nmesox<� <br /> CONTRACTOR I�' D/�437{C� 12 S4' L 8 I Lic.# �0 0�7C�S 2 COE Bus. Lic.# <br /> Address .S�L15/�{-j4L'1 s� !�.31/ PhonelEmail 3(pG 6^ 6(j <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E�mail �-�+-'�N� �+�J��O �Sf , <br /> BUILDINGPEYtMITAPPLICATION CONTRAC7PRICEOFWORK <br /> Existing Use of Building ''ers�'�hN3�Tl� �HEAT iOURCE: <br /> Proposed Use of Building �,S,//YJ�i✓'T//Q-� Gas ^ Eleceic_ Other_ <br /> Building type: _Single Family p Duplex_Townhouse _Multi-Family _Commercial <br /> T pe of pro'ec; New Addition Remodel Re air T.I. Si n Sprinkler Demnlilion Chan e of Use <br /> � DESCRIPTIONOFWORK(additiona�spacepmvidedontheback): <br /> ��L�C,� GA-S F-fJ��� <br /> MECHANICAL PERMIT APPLICATlON PLUMBIMG PERMIT APPLICATION <br /> Type of Project: _New_Addn _A��eration_Repair Type of Project: _New_Addn _Alteration_Repa(r <br /> Show Number(#)o/(xtures Show Number(0)o/fixtures <br /> A/C-airhandlin units I Toilet <br /> I Forced air s stems I BathWb <br /> ' Gas pipin Lavalo (wash basin) <br /> Water heater I Shower <br /> Gas freplace I Kitchen sink 8 disposal <br /> Gas ran e I Dishwasher <br /> Clothes d er I Clothes washer <br /> Ran e hood I Water heater <br /> II Exhaust fan I Sink(service/badmo lztc.) <br /> Heal ump I 9ackFlow reventer <br /> II Unit healer Urinal <br /> � Boiler I Drinkin Fountain <br /> I Refri eretion I Floordrain <br /> I Woodstove I Grease tra <br /> �� Ductin Rootdrains <br /> � Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Other. <br /> Number of Heads � Other: <br /> � I nere0y ceniy Ilial I�ave reatl ane e[amined Ihis appGcation anE knor�ihe same tn be Irue anE cortecl.Atl pmvisions ol laws and ortlinances 9oveming Mis rype ol work wil oe mmplie0 <br /> wilhwhetherspetified�ere nol.Thag2ntingo � tloesnolprasumetogiveaulhortylovb'ateorc2nxlViepmvi5bnolanyal�erslateorbcallawregulatingconsWction <br /> Tlial l a a �onzeA Gy e ow r ot this pm e lo perlorm M1e work lorwhich apptlralion is made:.nu I compty xr�Ne Slato Coatraqors Law 1827 RCW an0 298200A WAC. <br /> � � �%� <br /> wner/Authorized Agent Signature le (Revised 62012) <br />